Provider Demographics
NPI:1760553093
Name:HUDNALL, STANLEY DAVID (MD)
Entity Type:Individual
Prefix:
First Name:STANLEY
Middle Name:DAVID
Last Name:HUDNALL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:S.
Other - Middle Name:DAVID
Other - Last Name:HUDNALL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:310 CEDAR STREET
Mailing Address - Street 2:BML 116B
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06520-8023
Mailing Address - Country:US
Mailing Address - Phone:203-737-1221
Mailing Address - Fax:203-785-3583
Practice Address - Street 1:310 CEDAR STREET
Practice Address - Street 2:BML 116B
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06520-8023
Practice Address - Country:US
Practice Address - Phone:203-737-1221
Practice Address - Fax:203-785-3583
Is Sole Proprietor?:No
Enumeration Date:2006-11-10
Last Update Date:2009-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ2611207ZP0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0105XAllopathic & Osteopathic PhysiciansPathologyClinical Pathology/Laboratory Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX134518302Medicaid
TX83304NMedicare ID - Type Unspecified
TX134518302Medicaid