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General NPI Number Information
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NPI Number | 1134863590
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Entity Type | Individual
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Provider Name | INDIANA XAVIER JUDY DO
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Gender | Male
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Dates
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Enumeration Date | 04/22/2022
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Last Update Date | 06/13/2025
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Provider Practice Location Address
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Address Line | 1 MELLON WAY
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City | LATROBE
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State | PA
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Zip | 15650-1197
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Country | US
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Telephone | 724-832-4095
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Fax | 724-830-8613
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Provider Business Mailing Address
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Address Line | 1 MELLON WAY
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City | LATROBE
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State | PA
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Zip | 15650-1197
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | OS024945
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License Number State | PA
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