Provider Demographics
NPI:1740494558
Name:HUDAK, JASON A (MD)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:A
Last Name:HUDAK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3246 US ROUTE 60 STE 5
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25705-2729
Mailing Address - Country:US
Mailing Address - Phone:304-733-5990
Mailing Address - Fax:304-733-5991
Practice Address - Street 1:3246 US ROUTE 60 STE 5
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25705-2729
Practice Address - Country:US
Practice Address - Phone:304-733-5990
Practice Address - Fax:304-733-5991
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2025-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV22791207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810009797Medicaid
WV3810009797Medicaid
4217761Medicare PIN