Basic Information
Provider Information | |||||||||
NPI: | 1114927092 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | HUDGINS | ||||||||
FirstName: | EARL | ||||||||
MiddleName: | MAXWELL | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 301 CONCOURSE BLVD STE 190 | ||||||||
Address2: |   | ||||||||
City: | GLEN ALLEN | ||||||||
State: | VA | ||||||||
PostalCode: | 230595759 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8045494030 | ||||||||
FaxNumber: | 8045494032 | ||||||||
Practice Location | |||||||||
Address1: | 5421 PATTERSON AVE | ||||||||
Address2: |   | ||||||||
City: | RICHMOND | ||||||||
State: | VA | ||||||||
PostalCode: | 232262003 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8042852006 | ||||||||
FaxNumber: | 8042852799 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 07/21/2005 | ||||||||
LastUpdateDate: | 02/25/2015 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207ZD0900X | 0101019279 | VA | Y |   | Allopathic & Osteopathic Physicians | Pathology | Dermatopathology |
ID Information
ID | Type | State | Issuer | Description | 5950066 | 05 | VA |   | MEDICAID | 60200 | 01 |   | SOUTHERN HEALTH | OTHER | 0300049 | 01 |   | UNITED HEALTHCARE | OTHER | 016022 | 01 |   | ANTHEM | OTHER | 070003919 | 01 |   | RAILROAD MEDICARE | OTHER | 511729 | 01 |   | AETNA | OTHER |