Healthcare Provider Details

I. General information

NPI: 1366547218
Provider Name (Legal Business Name): JODY K JUDGE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 01/04/2022
Certification Date: 01/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

61 LINCOLN ST SUITE 212
FRAMINGHAM MA
01702-8264
US

IV. Provider business mailing address

50 STANIFORD ST SUITE 600
BOSTON MA
02114-2517
US

V. Phone/Fax

Practice location:
  • Phone: 508-875-9787
  • Fax: 508-872-3472
Mailing address:
  • Phone: 617-367-4800
  • Fax: 617-723-7028

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number80003
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: