Provider Demographics
NPI:1790848760
Name:ALBERT H DUDLEY III MD LLC
Entity Type:Organization
Organization Name:ALBERT H DUDLEY III MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:ALBERT
Authorized Official - Middle Name:HENRY
Authorized Official - Last Name:DUDLEY
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:410-683-2124
Mailing Address - Street 1:1 TEXAS STATION CT
Mailing Address - Street 2:STE 300
Mailing Address - City:TIMONIUM
Mailing Address - State:MD
Mailing Address - Zip Code:21093-8286
Mailing Address - Country:US
Mailing Address - Phone:410-683-2124
Mailing Address - Fax:410-683-3492
Practice Address - Street 1:1 TEXAS STATION CT
Practice Address - Street 2:STE 300
Practice Address - City:TIMONIUM
Practice Address - State:MD
Practice Address - Zip Code:21093-8286
Practice Address - Country:US
Practice Address - Phone:410-683-2124
Practice Address - Fax:410-683-3492
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0022935174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD266SMedicare ID - Type Unspecified
MDD66488Medicare UPIN