Provider Demographics
NPI:1023285335
Name:HUDDLESTON, HANNAH MICHAELE (MD)
Entity type:Individual
Prefix:
First Name:HANNAH
Middle Name:MICHAELE
Last Name:HUDDLESTON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:HANNAH
Other - Middle Name:MICHAELE
Other - Last Name:STRICKLAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:5050 SNOWY RIDGE LN
Mailing Address - Street 2:
Mailing Address - City:EARLYSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22936-1835
Mailing Address - Country:US
Mailing Address - Phone:317-201-0836
Mailing Address - Fax:
Practice Address - Street 1:5050 SNOWY RIDGE LN
Practice Address - Street 2:
Practice Address - City:EARLYSVILLE
Practice Address - State:VA
Practice Address - Zip Code:22936-1835
Practice Address - Country:US
Practice Address - Phone:317-201-0836
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-15
Last Update Date:2023-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01064846A207N00000X
VA0101272119207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN061500VMedicare UPIN