Basic Information
| Provider Information | |||||||||
| NPI: | 1619961893 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JUDD | ||||||||
| FirstName: | JAMES | ||||||||
| MiddleName: | D | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 606 | ||||||||
| Address2: | |||||||||
| City: | HATBORO | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190400606 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2156751516 | ||||||||
| FaxNumber: | 2156750901 | ||||||||
| Practice Location | |||||||||
| Address1: | 345 N YORK RD | ||||||||
| Address2: | |||||||||
| City: | HATBORO | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190402045 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2156751516 | ||||||||
| FaxNumber: | 2156759176 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/02/2005 | ||||||||
| LastUpdateDate: | 01/13/2011 | ||||||||
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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 | 207Q00000X | MD025331E | PA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 000922384-0002 | 05 | PA | MEDICAID |