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Individual

JODI V HODGE

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PA-C

Contact information

Practice address
196 PARKWAY S, SUITE 303, WATERFORD, CT 06385-1234
(860) 443-4455
(860) 447-8961
Mailing address
196 PARKWAY S, SUITE 304, WATERFORD, CT 06385-1234
(860) 442-7027
(860) 444-0074

Taxonomy

Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
001462
CT

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
001462
STATE LICENSE
CT
Enumeration date
07/29/2009
Last updated
07/29/2009
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