Healthcare Provider Details

I. General information

NPI: 1922885003
Provider Name (Legal Business Name): ANGELA HUDGENS CO, CPED
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/12/2023
Last Update Date: 09/12/2023
Certification Date: 09/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4762 CAREA RD
WHITE HALL MD
21161-8969
US

IV. Provider business mailing address

4762 CAREA RD
WHITE HALL MD
21161-8969
US

V. Phone/Fax

Practice location:
  • Phone: 301-535-6070
  • Fax:
Mailing address:
  • Phone: 301-535-6070
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code222Z00000X
TaxonomyOrthotist
License Number
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code224L00000X
TaxonomyPedorthist
License Number
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: