Provider Demographics
NPI:1750345385
Name:HUDSON, BRAD STEVEN (DMSC, PA-C)
Entity type:Individual
Prefix:
First Name:BRAD
Middle Name:STEVEN
Last Name:HUDSON
Suffix:
Gender:
Credentials:DMSC, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:750 KINGS HIGHWAY
Mailing Address - Street 2:SUITE 110
Mailing Address - City:LEWES
Mailing Address - State:DE
Mailing Address - Zip Code:19958
Mailing Address - Country:US
Mailing Address - Phone:302-644-6400
Mailing Address - Fax:302-644-6409
Practice Address - Street 1:750 KINGS HIGHWAY
Practice Address - Street 2:SUITE 110
Practice Address - City:LEWES
Practice Address - State:DE
Practice Address - Zip Code:19958
Practice Address - Country:US
Practice Address - Phone:302-644-6400
Practice Address - Fax:302-644-6409
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-12
Last Update Date:2025-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC50000344363AM0700X
DEC5-0000344363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE250505245Medicaid
G00075Medicare ID - Type UnspecifiedGROUP #