MEDICARE: KRISTIN MARA HUDOCK 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	207RC0200X	Critical Care Medicine (Internal Medicine) Physician	35126355	OH
2	207RC0200X	Critical Care Medicine (Internal Medicine) Physician	MD435541	PA
3	207RP1001X	Pulmonary Disease Physician	35126355	OH

General Provider Information

NPI Number	:	1649282492
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTIN MARA HUDOCK MD

Provider Business Mailing Address
First Line	:	PO BOX 636256
Second Line	:	CENTRAL CREDENTIALING
City	:	CINCINNATI
State	:	OH
Zip	:	45263-6256
Country	:	US
Telephone Number	:	513-245-3600
Fax Number	:	513-245-3672

Provider Business Practice Location Address
First Line	:	231 ALBERT SABIN WAY
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45267-2827
Country	:	US
Telephone Number	:	513-558-0588
Fax Number	:	513-558-4858

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

Provider Enumeration Date	:	08/12/2006
Last Update Date	:	05/18/2017

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