Healthcare Provider Details

I. General information

NPI: 1790700623
Provider Name (Legal Business Name): JUDITH I. JUSTMAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1020 SANSOM STREET
PHILADELPHIA PA
19107-5004
US

IV. Provider business mailing address

615 CHESTNUT ST 14TH FLOOR, CENTRAL ENROLLMENT
PHILADELPHIA PA
19106-4404
US

V. Phone/Fax

Practice location:
  • Phone: 215-955-6844
  • Fax: 215-955-2526
Mailing address:
  • Phone: 215-955-9655
  • Fax: 215-955-2420

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMD-032554-E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: