Provider Demographics
NPI:1760467237
Name:HUDED, PRAKASH V (MD)
Entity Type:Individual
Prefix:DR
First Name:PRAKASH
Middle Name:V
Last Name:HUDED
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:78 MARLBOROUGH ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:CT
Mailing Address - Zip Code:06480-4801
Mailing Address - Country:US
Mailing Address - Phone:860-342-4800
Mailing Address - Fax:860-342-3298
Practice Address - Street 1:78 MARLBOROUGH ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:CT
Practice Address - Zip Code:06480-4801
Practice Address - Country:US
Practice Address - Phone:860-342-4800
Practice Address - Fax:860-342-3298
Is Sole Proprietor?:No
Enumeration Date:2005-12-07
Last Update Date:2015-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT25374207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1253749Medicaid
110001169Medicare ID - Type Unspecified
CT1253749Medicaid