Provider Demographics
NPI:1144205808
Name:HUDYMA, EUGENE O (DPM)
Entity Type:Individual
Prefix:DR
First Name:EUGENE
Middle Name:O
Last Name:HUDYMA
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7836 OAKWOOD RD
Mailing Address - Street 2:STE A
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21061-4298
Mailing Address - Country:US
Mailing Address - Phone:410-768-6011
Mailing Address - Fax:410-768-6012
Practice Address - Street 1:7836 OAKWOOD RD
Practice Address - Street 2:STE A
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-4298
Practice Address - Country:US
Practice Address - Phone:410-768-6011
Practice Address - Fax:410-768-6012
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-14
Last Update Date:2010-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD00888213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD379248000Medicaid
MD480034105OtherPALMETTO GBA MEDICARE RR
T59878Medicare UPIN