MEDICARE: JUDY B DAVIDOFF M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	D0052384	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1396781712
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUDY B DAVIDOFF M.D.

Provider Business Mailing Address
First Line	:	1111 N. CHARLES ST.
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21201-5403
Country	:	US
Telephone Number	:	410-837-2050
Fax Number	:	410-837-2071

Provider Business Practice Location Address
First Line	:	8507 LIBERTY RD
Second Line	:
City	:	RANDALLSTOWN
State	:	MD
Zip	:	21133-4819
Country	:	US
Telephone Number	:	410-496-6441
Fax Number	:	410-496-6448

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/22/2006
Last Update Date	:	09/18/2013

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