Healthcare Provider Details

I. General information

NPI: 1255409744
Provider Name (Legal Business Name): BROOKE G JUDD MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2006
Last Update Date: 11/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MEDICAL CENTER DRIVE
LEBANON NH
03756-0001
US

IV. Provider business mailing address

1 MEDICAL CENTER DRIVE
LEBANON NH
03756-0001
US

V. Phone/Fax

Practice location:
  • Phone: 603-650-7232
  • Fax: 603-650-9478
Mailing address:
  • Phone: 603-650-7232
  • Fax: 603-650-9478

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number042.0010302
License Number StateVT
# 2
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number042.0010302
License Number StateVT
# 3
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number042.0010302
License Number StateVT
# 4
Primary TaxonomyY
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number10394
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: