MEDICARE: MATTHEW G HUDSON MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	60070	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	35.151170	OTHER	OH	OHIO LICENSURE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	60070	OTHER	KY	KY LICENSURE
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1457938938
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MATTHEW G HUDSON MD

Provider Business Mailing Address
First Line	:	137 STATE ROUTE 3117
Second Line	:
City	:	SOUTH SHORE
State	:	KY
Zip	:	41175-9597
Country	:	US
Telephone Number	:	606-932-2079
Fax Number	:	606-932-2313

Provider Business Practice Location Address
First Line	:	137 STATE ROUTE 3117
Second Line	:
City	:	SOUTH SHORE
State	:	KY
Zip	:	41175-9597
Country	:	US
Telephone Number	:	606-932-2079
Fax Number	:	606-932-2313

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/29/2021
Last Update Date	:	09/27/2024

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Directions to “ MATTHEW G HUDSON MD” Practice Location

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