Healthcare Provider Details

I. General information

NPI: 1619961893
Provider Name (Legal Business Name): JAMES D JUDD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2005
Last Update Date: 01/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

345 N YORK RD
HATBORO PA
19040-2045
US

IV. Provider business mailing address

PO BOX 606
HATBORO PA
19040-0606
US

V. Phone/Fax

Practice location:
  • Phone: 215-675-1516
  • Fax: 215-675-9176
Mailing address:
  • Phone: 215-675-1516
  • Fax: 215-675-0901

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD025331E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: