Provider Demographics
NPI:1861472938
Name:HUDSON, CLIFFORD C (MD)
Entity Type:Individual
Prefix:DR
First Name:CLIFFORD
Middle Name:C
Last Name:HUDSON
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 1:672 S HAMPTON AT WATERFORD
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-7863
Mailing Address - Country:US
Mailing Address - Phone:717-751-6426
Mailing Address - Fax:
Practice Address - Street 1:1232 GREENSPRINGS DR
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17402-8825
Practice Address - Country:US
Practice Address - Phone:717-755-6166
Practice Address - Fax:717-755-6054
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD030646L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAC30022Medicare UPIN
PA102325N84Medicare ID - Type Unspecified