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General NPI Number Information
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NPI Number | 1760649875
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Entity Type | Individual
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Provider Name | THOMAS EUGENE LAJUDICE CNP
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Gender | Male
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Dates
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Enumeration Date | 05/19/2008
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Last Update Date | 05/19/2008
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Provider Practice Location Address
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Address Line | 106 BOW ST
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City | ELKTON
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State | MD
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Zip | 21921-5544
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Country | US
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Telephone | 443-907-3592
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Fax |
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Provider Business Mailing Address
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Address Line | 208 NORTHBEND CT
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City | NEWARK
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State | DE
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Zip | 19702-2122
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Country | US
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Telephone | 302-456-1577
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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 | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | LB-0000168
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License Number State | DE
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