Provider Demographics
NPI:1457938938
Name:HUDSON, MATTHEW G (MD)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:G
Last Name:HUDSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:137 STATE ROUTE 3117
Mailing Address - Street 2:
Mailing Address - City:SOUTH SHORE
Mailing Address - State:KY
Mailing Address - Zip Code:41175-9597
Mailing Address - Country:US
Mailing Address - Phone:606-932-2079
Mailing Address - Fax:606-932-2313
Practice Address - Street 1:137 STATE ROUTE 3117
Practice Address - Street 2:
Practice Address - City:SOUTH SHORE
Practice Address - State:KY
Practice Address - Zip Code:41175-9597
Practice Address - Country:US
Practice Address - Phone:606-932-2079
Practice Address - Fax:606-932-2313
Is Sole Proprietor?:No
Enumeration Date:2021-03-29
Last Update Date:2024-09-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY60070208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH35.151170OtherOHIO LICENSURE
OH0057270Medicaid
KY60070OtherKY LICENSURE
KY7100834770Medicaid