MEDICARE: EARL MAXWELL HUDGINS MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207ZD0900X	Dermatopathology (Pathology) Physician	0101019279	VA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
5	070003919	OTHER		RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	60200	OTHER	SOUTHERN HEALTH
3	0300049	OTHER	UNITED HEALTHCARE
4	016022	OTHER	ANTHEM
6	511729	OTHER	AETNA

General Provider Information

NPI Number	:	1114927092
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EARL MAXWELL HUDGINS MD

Provider Business Mailing Address
First Line	:	301 CONCOURSE BLVD STE 190
Second Line	:
City	:	GLEN ALLEN
State	:	VA
Zip	:	23059-5759
Country	:	US
Telephone Number	:	804-549-4030
Fax Number	:	804-549-4032

Provider Business Practice Location Address
First Line	:	5421 PATTERSON AVE
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23226-2003
Country	:	US
Telephone Number	:	804-285-2006
Fax Number	:	804-285-2799

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/21/2005
Last Update Date	:	02/25/2015

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