Provider Demographics
NPI:1043373400
Name:KERNODLE, JUDITH M (MD)
Entity Type:Individual
Prefix:DR
First Name:JUDITH
Middle Name:M
Last Name:KERNODLE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2097 ROUTE 30
Mailing Address - Street 2:
Mailing Address - City:DORSET
Mailing Address - State:VT
Mailing Address - Zip Code:05251-9411
Mailing Address - Country:US
Mailing Address - Phone:201-819-6181
Mailing Address - Fax:
Practice Address - Street 1:2097 ROUTE 30
Practice Address - Street 2:
Practice Address - City:DORSET
Practice Address - State:VT
Practice Address - Zip Code:05251-9411
Practice Address - Country:US
Practice Address - Phone:201-819-6181
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2021-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ#25MAD63090002084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ829085Medicare ID - Type Unspecified