Provider Demographics
NPI:1114970092
Name:KUDRIA, INNA (MD)
Entity Type:Individual
Prefix:
First Name:INNA
Middle Name:
Last Name:KUDRIA
Suffix:
Gender:F
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:PO BOX 2000
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:NY
Mailing Address - Zip Code:12534-2000
Mailing Address - Country:US
Mailing Address - Phone:518-828-8363
Mailing Address - Fax:518-697-3388
Practice Address - Street 1:71 PROSPECT AVE
Practice Address - Street 2:SUITE 210
Practice Address - City:HUDSON
Practice Address - State:NY
Practice Address - Zip Code:12534-2907
Practice Address - Country:US
Practice Address - Phone:518-828-3327
Practice Address - Fax:518-697-8158
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2009-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1-211095207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
04026007325OtherFIDELIS
087073OtherMVP
141503OtherWELLCARE
43363OtherGHI HMO
000492006001OtherBSNENY
1933944OtherUNITED HEALTH CARE
5771C1OtherBC/BS
5999073OtherGHI PPO
080139872OtherRAILROAD CARE
10032025OtherCDPHP
NY01866077Medicaid
000492006001OtherBSNENY
5999073OtherGHI PPO
04026007325OtherFIDELIS