=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114061454
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SADEKA J JUDE MD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/19/2007
-----------------------------------------------------
Last Update Date | 06/07/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4225 ALTAMONT PL SUITE 102
-----------------------------------------------------
City | WHITE PLAINS
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20695-3063
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-870-9900
-----------------------------------------------------
Fax | 301-870-6458
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10403 HOSPITAL DR STE G4
-----------------------------------------------------
City | CLINTON
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20735-3134
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-856-3019
-----------------------------------------------------
Fax | 301-856-9370
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207V00000X
-----------------------------------------------------
Taxonomy Name | Obstetrics & Gynecology Physician
-----------------------------------------------------
License Number | D0069655
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------