Provider Demographics
NPI:1174793087
Name:EUGENE O HUDYMA DPM
Entity type:Organization
Organization Name:EUGENE O HUDYMA DPM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCOUNTS
Authorized Official - Prefix:MRS
Authorized Official - First Name:JOYCE
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-768-6011
Mailing Address - Street 1:7836 OAKWOOD RD STE A
Mailing Address - Street 2:
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21061-4298
Mailing Address - Country:US
Mailing Address - Phone:410-768-6011
Mailing Address - Fax:410-768-6012
Practice Address - Street 1:7836 OAKWOOD RD STE A
Practice Address - Street 2:
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-4298
Practice Address - Country:US
Practice Address - Phone:410-768-6011
Practice Address - Fax:410-768-6012
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-06
Last Update Date:2008-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD00888213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1069540001Medicare NSC