Provider Demographics
NPI:1790753374
Name:HUDOCK, STEPHEN ALBERT (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:ALBERT
Last Name:HUDOCK
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 1:1 GUTHRIE SQ
Mailing Address - Street 2:
Mailing Address - City:SAYRE
Mailing Address - State:PA
Mailing Address - Zip Code:18840-1625
Mailing Address - Country:US
Mailing Address - Phone:570-888-5858
Mailing Address - Fax:
Practice Address - Street 1:1 GUTHRIE SQ
Practice Address - Street 2:
Practice Address - City:SAYRE
Practice Address - State:PA
Practice Address - Zip Code:18840-1625
Practice Address - Country:US
Practice Address - Phone:570-888-5858
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2021-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD027486E207W00000X, 207WX0009X
NY169815-1207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0009XAllopathic & Osteopathic PhysiciansOphthalmologyGlaucoma Specialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA150040317OtherRR MEDICARE PIN
NYCC8362OtherRR MEDICARE GROUP
PAGU039847OtherMEDICARE GROUP
NYP00329050OtherRR MEDICARE PIN
PACC9269OtherRR MEDICARE GROUP
NYP00329050OtherRR MEDICARE PIN
NYCC8362OtherRR MEDICARE GROUP
A61509Medicare UPIN
PA0010881940001Medicare ID - Type Unspecified
NY01031570Medicare ID - Type Unspecified