Provider Demographics
NPI:1275523698
Name:DUDLEY, DAVID WATSON (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:WATSON
Last Name:DUDLEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:300 MEDICAL DR
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23666-1765
Mailing Address - Country:US
Mailing Address - Phone:757-788-0092
Mailing Address - Fax:757-788-0969
Practice Address - Street 1:300 MEDICAL DR
Practice Address - Street 2:2ND FLOOR
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23666-1765
Practice Address - Country:US
Practice Address - Phone:757-788-0201
Practice Address - Fax:757-788-0950
Is Sole Proprietor?:No
Enumeration Date:2005-10-26
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA01010510362084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1659424448Medicaid
VAB64420Medicare UPIN
VA011596H14Medicare PIN