Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | 164713 | NY |
N | 207R00000X | Internist | 164713 | NY |
N | 111NI0900X | Internist | 164713 | NY |
N | 207RA0401X | Internist - Addiction Medicine | 164713 | NY |
NPI | 1811947641 |
---|---|
Provider Name | Dr. Michael J Hodgman |
First Address | Cooperstown, NY 13326-1301 |
Second Address | Cooperstown, NY 13326-1301 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/05/2006 |
Last Update Date | 26/04/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01185437 | (05) | NY |
D77508 | (02) | NY |