Provider Demographics
NPI:1962593509
Name:HUDAK, DEBORAH KESSLER (MD)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:KESSLER
Last Name:HUDAK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:DEBORAH
Other - Middle Name:FLORENCE
Other - Last Name:KESSLER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 99717
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27624-9717
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8311 BANDFORD WAY
Practice Address - Street 2:SUITE 103
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-2756
Practice Address - Country:US
Practice Address - Phone:919-845-0333
Practice Address - Fax:919-845-0773
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2008-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9800932207NS0135X, 207W00000X, 2082S0099X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
No2082S0099XAllopathic & Osteopathic PhysiciansPlastic SurgeryPlastic Surgery Within the Head and Neck
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8911904Medicaid
NC8911904Medicaid
NC2279648AMedicare PIN