Healthcare Provider Details

I. General information

NPI: 1851398291
Provider Name (Legal Business Name): CONSTANCE M JUDGE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CONSTANCE M PALLANTE MD

II. Dates (important events)

Enumeration Date: 06/30/2005
Last Update Date: 11/20/2020
Certification Date: 11/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35010 CHARDON RD SUITE 205
WILLOUGHBY OH
44094-9010
US

IV. Provider business mailing address

35010 CHARDON RD SUITE 205
WILLOUGHBY OH
44094-9010
US

V. Phone/Fax

Practice location:
  • Phone: 440-918-0501
  • Fax: 440-918-0525
Mailing address:
  • Phone: 440-918-0501
  • Fax: 440-918-0525

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35066650J
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: