Provider Demographics
NPI:1003815150
Name:WALIGUNDA, JUDITH ANN (MD)
Entity Type:Individual
Prefix:DR
First Name:JUDITH
Middle Name:ANN
Last Name:WALIGUNDA
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:125 PARKER HILL AVE
Mailing Address - Street 2:SUITE #450
Mailing Address - City:ROXBURY CROSSING
Mailing Address - State:MA
Mailing Address - Zip Code:02120-2847
Mailing Address - Country:US
Mailing Address - Phone:617-754-5910
Mailing Address - Fax:617-754-5950
Practice Address - Street 1:125 PARKER HILL AVE
Practice Address - Street 2:SUITE #450
Practice Address - City:ROXBURY CROSSING
Practice Address - State:MA
Practice Address - Zip Code:02120-2847
Practice Address - Country:US
Practice Address - Phone:617-754-5910
Practice Address - Fax:617-754-5950
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-20
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA41966207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
62111OtherHARVARD PILGRIM HEALTH CA
MA0128457Medicaid
04-01335OtherUNITED HEALTH CARE
MA0128457Medicaid
04-01335OtherUNITED HEALTH CARE