Provider Demographics
NPI:1083677157
Name:HUDSON, IVET E (MD)
Entity Type:Individual
Prefix:DR
First Name:IVET
Middle Name:E
Last Name:HUDSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1818 HENDERSON ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29201-2619
Mailing Address - Country:US
Mailing Address - Phone:803-782-4278
Mailing Address - Fax:803-782-3445
Practice Address - Street 1:4200 E NORTH ST
Practice Address - Street 2:SUITE 5
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-2437
Practice Address - Country:US
Practice Address - Phone:864-292-2266
Practice Address - Fax:864-292-8356
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2009-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC21932207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H47751Medicare UPIN
SC219329Medicare ID - Type Unspecified
H47751Medicare ID - Type Unspecified