Provider Demographics
NPI:1982713640
Name:HODDINOTT, MARK BENNETT (MD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:BENNETT
Last Name:HODDINOTT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:715 S COY RD
Mailing Address - Street 2:
Mailing Address - City:OREGON
Mailing Address - State:OH
Mailing Address - Zip Code:43616-3007
Mailing Address - Country:US
Mailing Address - Phone:419-698-9711
Mailing Address - Fax:419-698-2841
Practice Address - Street 1:4005 ORCHARD DR
Practice Address - Street 2:MID MICHIGAN MEDICAL CENTER
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48670-0001
Practice Address - Country:US
Practice Address - Phone:989-839-3476
Practice Address - Fax:989-839-1395
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2008-05-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH35073771207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
F10156Medicare UPIN