1205801743 NPI number — DR. CHAD EMMETT HUDSON MD, PHD

Table of content: DARYOUSH EMAMI (NPI 1871152710)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205801743 NPI number — DR. CHAD EMMETT HUDSON MD, PHD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HUDSON
Provider First Name:
CHAD
Provider Middle Name:
EMMETT
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD, PHD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1205801743
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/18/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1616 ASHLEY RIVER RD
Provider Second Line Business Mailing Address:
WEST ASHLEY COLONOSCOPY CENTER
Provider Business Mailing Address City Name:
CHARLESTON
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29407
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
843-556-1285
Provider Business Mailing Address Fax Number:
843-556-1286

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1616 ASHLEY RIVER RD
Provider Second Line Business Practice Location Address:
WEST ASHLEY COLONOSCOPY CENTER
Provider Business Practice Location Address City Name:
CHARLESTON
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29407
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
843-556-1285
Provider Business Practice Location Address Fax Number:
843-556-1286
Provider Enumeration Date:
02/20/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X , with the licence number:  D0063570 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207V00000X , with the licence number: MD39554 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 409277500 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".