Healthcare Provider Details

I. General information

NPI: 1679510382
Provider Name (Legal Business Name): KORIN B HUDSON FABIAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KORIN B HUDSON MD

II. Dates (important events)

Enumeration Date: 06/01/2006
Last Update Date: 05/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 IRVING ST NW
WASHINGTON DC
20010-2976
US

IV. Provider business mailing address

6858 OLD DOMINION DR STE 202
MC LEAN VA
22101-3899
US

V. Phone/Fax

Practice location:
  • Phone: 202-877-7632
  • Fax: 610-834-2862
Mailing address:
  • Phone: 703-288-2790
  • Fax: 703-288-2799

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207PS0010X
TaxonomySports Medicine (Emergency Medicine) Physician
License NumberE0101238136
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMD035967
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: