Individual
DR. THEO WALLACE HODGE JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1140 VARNUM ST NE, WASHINGTON, DC 20017-2151
(405) 220-2854
(202) 854-4832
Mailing address
1140 VARNUM ST NE STE 203, WASHINGTON, DC 20017-2153
(202) 525-5175
(202) 450-6088
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
MD18133
DC
207RI0200X
Infectious Disease Physician
Primary
MD18133
DC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
G22464
UPIN
DC
Enumeration date
09/22/2006
Last updated
05/17/2023
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