Provider Demographics
NPI:1346243185
Name:HUDAK, REGINA MARIE (PA-C)
Entity Type:Individual
Prefix:
First Name:REGINA
Middle Name:MARIE
Last Name:HUDAK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:575 COAL VALLEY RD
Mailing Address - Street 2:SUITE 374
Mailing Address - City:CLAIRTON
Mailing Address - State:PA
Mailing Address - Zip Code:15025-3730
Mailing Address - Country:US
Mailing Address - Phone:412-469-7744
Mailing Address - Fax:412-469-7766
Practice Address - Street 1:575 COAL VALLEY RD
Practice Address - Street 2:SUITE 374
Practice Address - City:CLAIRTON
Practice Address - State:PA
Practice Address - Zip Code:15025-3730
Practice Address - Country:US
Practice Address - Phone:412-469-7744
Practice Address - Fax:412-469-7766
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2016-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA051718363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1346243185OtherNPI
PA083920NCAMedicare ID - Type Unspecified
PA1346243185OtherNPI