Healthcare Provider Details

I. General information

NPI: 1265448955
Provider Name (Legal Business Name): MARK ANDREW KUDES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 06/05/2020
Certification Date: 06/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

670 LAWN AVE SUITE 3A
SELLERSVILLE PA
18960-1571
US

IV. Provider business mailing address

PO BOX 1111
HARLEYSVILLE PA
19438-0907
US

V. Phone/Fax

Practice location:
  • Phone: 215-257-9500
  • Fax: 215-257-3578
Mailing address:
  • Phone: 215-453-4995
  • Fax: 215-453-4646

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberMD430897
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: