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General NPI Number Information
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NPI Number | 1376768234
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Entity Type | Individual
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Provider Name | MICHELLE T CHUDOW MD
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Gender | Female
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Dates
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Enumeration Date | 04/16/2007
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Last Update Date | 09/19/2022
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Provider Practice Location Address
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Address Line | 1708 W ROGERS AVE DEPT OF
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City | BALTIMORE
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State | MD
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Zip | 21209-4596
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Country | US
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Telephone | 410-578-5202
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Fax | 410-367-4196
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Provider Business Mailing Address
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Address Line | PO BOX 13579
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City | READING
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State | PA
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Zip | 19612-3579
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Country | US
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Telephone | 484-628-0797
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | D0068848
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License Number State | MD
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