Healthcare Provider Details

I. General information

NPI: 1740417039
Provider Name (Legal Business Name): SARAH HUDSON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SARAH GRIMM MD

II. Dates (important events)

Enumeration Date: 06/15/2009
Last Update Date: 06/29/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

322 LAKE AVE
ROCHESTER NY
14608-1162
US

IV. Provider business mailing address

214C LAKE AVE
ROCHESTER NY
14608
US

V. Phone/Fax

Practice location:
  • Phone: 585-254-6480
  • Fax:
Mailing address:
  • Phone: 585-423-5800
  • Fax: 585-423-2583

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number241076
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number04200543
License Number StateVT
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number288323
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: