=====================================================
General NPI Number Information
=====================================================
NPI Number | 1821099508
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KATHLEEN ST. JOHN IUDICA M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/03/2005
-----------------------------------------------------
Last Update Date | 03/29/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1831 RESERVOIR ST
-----------------------------------------------------
City | HARRISONBURG
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22801-8743
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 540-433-9151
-----------------------------------------------------
Fax | 540-433-0547
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1831 RESERVOIR ST
-----------------------------------------------------
City | HARRISONBURG
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22801-8743
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 540-433-9151
-----------------------------------------------------
Fax | 540-433-0547
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 0101223187
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------