Healthcare Provider Details

I. General information

NPI: 1750345385
Provider Name (Legal Business Name): BRAD STEVEN HUDSON DMSC, PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/12/2006
Last Update Date: 02/21/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 KINGS HIGHWAY SUITE 110
LEWES DE
19958
US

IV. Provider business mailing address

750 KINGS HIGHWAY SUITE 110
LEWES DE
19958
US

V. Phone/Fax

Practice location:
  • Phone: 302-644-6400
  • Fax: 302-644-6409
Mailing address:
  • Phone: 302-644-6400
  • Fax: 302-644-6409

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberC50000344
License Number StateDE
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberC5-0000344
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: