Provider Demographics
NPI:1871705392
Name:HUDES, DEBRA LYNN (MD)
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:LYNN
Last Name:HUDES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:909 WALNUT ST
Mailing Address - Street 2:FL 2
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-5211
Mailing Address - Country:US
Mailing Address - Phone:215-955-7000
Mailing Address - Fax:
Practice Address - Street 1:6500 TABOR RD
Practice Address - Street 2:COMMONS BUILDING 2ND FL
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19111-5332
Practice Address - Country:US
Practice Address - Phone:215-697-8500
Practice Address - Fax:215-697-8502
Is Sole Proprietor?:No
Enumeration Date:2007-05-04
Last Update Date:2021-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD029767E207R00000X, 207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1028534Medicaid
PAC34435Medicare UPIN
PA465543JTQMedicare PIN