Provider Demographics
NPI:1114927092
Name:HUDGINS, EARL MAXWELL (MD)
Entity Type:Individual
Prefix:
First Name:EARL
Middle Name:MAXWELL
Last Name:HUDGINS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 CONCOURSE BLVD STE 190
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23059-5759
Mailing Address - Country:US
Mailing Address - Phone:804-549-4030
Mailing Address - Fax:804-549-4032
Practice Address - Street 1:5421 PATTERSON AVE
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23226-2003
Practice Address - Country:US
Practice Address - Phone:804-285-2006
Practice Address - Fax:804-285-2799
Is Sole Proprietor?:No
Enumeration Date:2005-07-21
Last Update Date:2015-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101019279207ZD0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZD0900XAllopathic & Osteopathic PhysiciansPathologyDermatopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA5950066Medicaid
60200OtherSOUTHERN HEALTH
0300049OtherUNITED HEALTHCARE
016022OtherANTHEM
070003919OtherRAILROAD MEDICARE
511729OtherAETNA
070003919OtherRAILROAD MEDICARE
B05907Medicare UPIN