Healthcare Provider Details

I. General information

NPI: 1972582575
Provider Name (Legal Business Name): MARTIN HUDZINSKI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2006
Last Update Date: 04/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10058 S MOUNTAIN RD
SOUTH MOUNTAIN PA
17261-0900
US

IV. Provider business mailing address

10058 S MOUNTAIN RD
SOUTH MOUNTAIN PA
17261-0900
US

V. Phone/Fax

Practice location:
  • Phone: 717-749-3121
  • Fax: 717-749-4071
Mailing address:
  • Phone: 717-749-3121
  • Fax: 717-749-4071

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD023873E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: