Healthcare Provider Details

I. General information

NPI: 1770674509
Provider Name (Legal Business Name): JUDITH MUND DISCHEL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 05/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

386 STANLEY ST
FALL RIVER MA
02720-6009
US

IV. Provider business mailing address

6 CLINTON PL
NEW BEDFORD MA
02740-4986
US

V. Phone/Fax

Practice location:
  • Phone: 508-679-5222
  • Fax:
Mailing address:
  • Phone: 508-207-2671
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LA0401X
TaxonomyAddiction Medicine (Anesthesiology) Physician
License Number150965
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: