Individual
KEVIN J MUDD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
262 BANK ST, BATAVIA, NY 14020-1537
(585) 344-3050
(585) 344-3043
Mailing address
262 BANK ST, BATAVIA, NY 14020-1537
(585) 344-3050
(585) 344-3043
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
198795
NY
2085R0001X
Radiation Oncology Physician
Primary
198795
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01685405
—
NY
01
—
35459A
MEDICARE GROUP PTAN
NY
Enumeration date
05/11/2006
Last updated
07/03/2023
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