Provider Demographics
NPI:1740275064
Name:CHUDACOFF, RICHARD MARTIN (MD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:MARTIN
Last Name:CHUDACOFF
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:100 N ACADEMY AVE
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17822-4903
Mailing Address - Country:US
Mailing Address - Phone:570-808-7916
Mailing Address - Fax:570-808-6006
Practice Address - Street 1:1155 EAST MTN BLVD
Practice Address - Street 2:
Practice Address - City:WILKES BARRE
Practice Address - State:PA
Practice Address - Zip Code:18702-7906
Practice Address - Country:US
Practice Address - Phone:570-808-7916
Practice Address - Fax:570-808-6006
Is Sole Proprietor?:No
Enumeration Date:2005-09-13
Last Update Date:2025-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD479668207V00000X, 207V00000X
NJ25MA10635300207V00000X
TXK5869207V00000X
DEC1-0028456207V00000X
NY319212207V00000X
VA0101266257207V00000X
FLME114379207VF0040X
CAG70841207V00000X
NV12108207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207VF0040XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyUrogynecology and Reconstructive Pelvic Surgery
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX11340275064Medicaid
FL115868400Medicaid