Provider Demographics
NPI:1508806407
Name:HUDAK, NICHOLAS MARK (PA-C)
Entity Type:Individual
Prefix:MR
First Name:NICHOLAS
Middle Name:MARK
Last Name:HUDAK
Suffix:
Gender:M
Credentials:PA-C
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Mailing Address - Street 1:DUKE UNIVERSITY PHYSICIAN
Mailing Address - Street 2:DUKE UNIVERSITY MEDICAL CENTER BOX 104780
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27710-0001
Mailing Address - Country:US
Mailing Address - Phone:919-681-3254
Mailing Address - Fax:919-681-9666
Practice Address - Street 1:DUKE UNIVERSITY MEDICAL CTR
Practice Address - Street 2:DUMC BOX 3894
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27710-0001
Practice Address - Country:US
Practice Address - Phone:919-684-8615
Practice Address - Fax:919-681-7936
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2010-04-29
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Provider Licenses
StateLicense IDTaxonomies
NC001002061363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHHUPA23811Medicare PIN
Q28401Medicare UPIN