Healthcare Provider Details

I. General information

NPI: 1629282306
Provider Name (Legal Business Name): JEREMY F CUDA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2007
Last Update Date: 05/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5221 US ROUTE 60
HUNTINGTON WV
25705-2022
US

IV. Provider business mailing address

5221 US ROUTE 60
HUNTINGTON WV
25705-2022
US

V. Phone/Fax

Practice location:
  • Phone: 304-522-1550
  • Fax: 304-522-0704
Mailing address:
  • Phone: 304-522-1550
  • Fax: 304-522-0704

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number24791
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberTP353
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number35.099135
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number2009-00703
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: