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General NPI Number Information
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NPI Number | 1629757877
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Entity Type | Individual
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Provider Name | MADELYN MARIE JUDGE PA-C
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Gender | Female
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Dates
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Enumeration Date | 07/14/2023
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Last Update Date | 11/12/2024
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Provider Practice Location Address
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Address Line | 4735 OGLETOWN STANTON RD STE 3301
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City | NEWARK
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State | DE
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Zip | 19713-7021
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Country | US
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Telephone | 302-623-4370
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Fax | 302-623-4375
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Provider Business Mailing Address
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Address Line | 600 S 43RD ST
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City | PHILADELPHIA
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State | PA
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Zip | 19104-4418
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | C0009651
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | C5-0012170
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License Number State | DE
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