Provider Demographics
NPI:1205801743
Name:HUDSON, CHAD EMMETT (MD, PHD)
Entity type:Individual
Prefix:DR
First Name:CHAD
Middle Name:EMMETT
Last Name:HUDSON
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1616 ASHLEY RIVER RD
Mailing Address - Street 2:WEST ASHLEY COLONOSCOPY CENTER
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29407
Mailing Address - Country:US
Mailing Address - Phone:843-556-1285
Mailing Address - Fax:843-556-1286
Practice Address - Street 1:1616 ASHLEY RIVER RD
Practice Address - Street 2:WEST ASHLEY COLONOSCOPY CENTER
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407
Practice Address - Country:US
Practice Address - Phone:843-556-1285
Practice Address - Fax:843-556-1286
Is Sole Proprietor?:No
Enumeration Date:2006-02-20
Last Update Date:2016-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0063570207V00000X
SCMD39554207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD409277500Medicaid
MD962LM660Medicare ID - Type UnspecifiedPROVIDER NUMBER
MD409277500Medicaid