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NPI Code Detail

MEDICARE: MARY BRANDT HUDELSON M.D.

MEDICARE: MARY BRANDT HUDELSON M.D.
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
1207K00000XAllergy & Immunology PhysicianH4184TX

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
3030003804OTHERTXRAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
182391SOTHERTXBC/BS
2AETNAOTHERTX4378428

General Provider Information

NPI Number : 1679530372
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARY BRANDT HUDELSON M.D.
Provider Business Mailing Address
First Line : 3051 CHURCHILL DR STE 130
Second Line :
City : FLOWER MOUND
State : TX
Zip : 75022-2710
Country : US
Telephone Number : 972-539-0086
Fax Number : 972-355-9680
Provider Business Practice Location Address
First Line : 3051 CHURCHILL DR
Second Line : STE 130
City : FLOWER MOUND
State : TX
Zip : 75022-2710
Country : US
Telephone Number : 972-539-0086
Fax Number : 972-355-9680
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/27/2006
Last Update Date : 01/08/2026

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