MEDICARE: STANLEY DAVID HUDNALL M.D.

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	207ZP0105X	Clinical Pathology/Laboratory Medicine Physician	J2611	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1760553093
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STANLEY DAVID HUDNALL M.D.

Provider Business Mailing Address
First Line	:	310 CEDAR STREET
Second Line	:	BML 116B
City	:	NEW HAVEN
State	:	CT
Zip	:	06520-8023
Country	:	US
Telephone Number	:	203-737-1221
Fax Number	:	203-785-3583

Provider Business Practice Location Address
First Line	:	310 CEDAR STREET
Second Line	:	BML 116B
City	:	NEW HAVEN
State	:	CT
Zip	:	06520-8023
Country	:	US
Telephone Number	:	203-737-1221
Fax Number	:	203-785-3583

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

Provider Enumeration Date	:	11/10/2006
Last Update Date	:	10/29/2009

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