Provider Demographics
NPI:1376668004
Name:ANGEVINE, ANNE HUDSON (MD)
Entity Type:Individual
Prefix:DR
First Name:ANNE
Middle Name:HUDSON
Last Name:ANGEVINE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ANNE
Other - Middle Name:ELIZABETH
Other - Last Name:HUDSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:14 WESTWAY
Mailing Address - Street 2:
Mailing Address - City:BRONXVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:10708-4311
Mailing Address - Country:US
Mailing Address - Phone:203-276-2695
Mailing Address - Fax:203-975-7842
Practice Address - Street 1:1 HOSPITAL PLAZA
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06904-9317
Practice Address - Country:US
Practice Address - Phone:203-276-2695
Practice Address - Fax:203-975-7842
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2019-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY227192207RH0003X
CT45726207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
No207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1376668004OtherNPI
CT004000360Medicaid
CT1376668004OtherNPI
CT830000187Medicare PIN
CTI16375Medicare UPIN