Provider Demographics
NPI:1306096425
Name:TUDOR, HILLARY VALENE (DPM)
Entity type:Individual
Prefix:
First Name:HILLARY
Middle Name:VALENE
Last Name:TUDOR
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3255 E LIVINGSTON AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43227-1923
Mailing Address - Country:US
Mailing Address - Phone:614-239-9444
Mailing Address - Fax:
Practice Address - Street 1:3255 E LIVINGSTON AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43227-1923
Practice Address - Country:US
Practice Address - Phone:614-239-9444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-25
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36.003585213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000726431OtherBCBS PIN
OHHO79162Medicare PIN
OHHO79161Medicare PIN
OHHO79160Medicare PIN
OHHO79163Medicare PIN