Basic Information
| Provider Information | |||||||||
| NPI: | 1518126531 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JUDELMAN | ||||||||
| FirstName: | KEVIN | ||||||||
| MiddleName: | MARC | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1307 FEDERAL ST | ||||||||
| Address2: | SUITE B300 | ||||||||
| City: | PITTSBURGH | ||||||||
| State: | PA | ||||||||
| PostalCode: | 152124769 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4123593751 | ||||||||
| FaxNumber: | 4123598439 | ||||||||
| Practice Location | |||||||||
| Address1: | 1307 FEDERAL ST | ||||||||
| Address2: | SUITE B300 | ||||||||
| City: | PITTSBURGH | ||||||||
| State: | PA | ||||||||
| PostalCode: | 152124769 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4123593751 | ||||||||
| FaxNumber: | 4123598439 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/05/2008 | ||||||||
| LastUpdateDate: | 10/11/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | MD434806 | PA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1021794000001 | 05 | PA | MEDICAID | P00629744 | 01 | PA | MEDICARE RAILROAD | OTHER |