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NPI Code Detail

MEDICARE: IDA HUDSON DO

MEDICARE:   IDA  HUDSON  DO
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
1207L00000XAnesthesiology Physician010076LPA

General Provider Information

NPI Number : 1275524084
Entity Type Code : Individual
Provider Name (Legal Business Name) : IDA HUDSON DO
Provider Business Mailing Address
First Line : 4400 EMERSON RD
Second Line :
City : WILMINGTON
State : DE
Zip : 19802-1210
Country : US
Telephone Number : 302-764-7060
Fax Number :
Provider Business Practice Location Address
First Line : 800 SPRUCE ST
Second Line :
City : PHILA
State : PA
Zip : 19107-6130
Country : US
Telephone Number : 215-829-5664
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/01/2005
Last Update Date : 01/05/2010

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Directions to “ IDA HUDSON DO” Practice Location

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