Provider Demographics
NPI:1003875899
Name:KAUDER, DAVID H (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:H
Last Name:KAUDER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 HIGHLAND AVE
Mailing Address - Street 2:SUITE 6
Mailing Address - City:SALEM
Mailing Address - State:MA
Mailing Address - Zip Code:01970-7003
Mailing Address - Country:US
Mailing Address - Phone:978-741-4133
Mailing Address - Fax:978-741-7742
Practice Address - Street 1:400 HIGHLAND AVE
Practice Address - Street 2:SUITE 6
Practice Address - City:SALEM
Practice Address - State:MA
Practice Address - Zip Code:01970-7003
Practice Address - Country:US
Practice Address - Phone:978-741-4133
Practice Address - Fax:978-741-7742
Is Sole Proprietor?:No
Enumeration Date:2006-03-21
Last Update Date:2010-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA41052208800000X
NMMD20040514208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2054833Medicaid
AK7634264OtherBNDD
MAD14266Medicare ID - Type Unspecified
MA2054833Medicaid
AK7634264OtherBNDD