Provider Demographics
NPI:1063504983
Name:JUDSON, PATRICIA L (MD)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:L
Last Name:JUDSON
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 1:1401 S 31ST ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19146-3506
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1401 S 31ST ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19146-3506
Practice Address - Country:US
Practice Address - Phone:215-925-4201
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN41648207V00000X
UT9426158-1205207V00000X
PAMD475526207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN36-11172OtherMEDICA-CHOICE
MN462327400Medicaid
MNHP29190OtherHEALTH PARTNERS
MN1021429OtherPREFERRED ONE
MN127255OtherU CARE
MN166439OtherFAIRVIEW
MN36-04052OtherMEDICA-PRIMARY
MN43R99JUOtherBLUE CROSS BLUE SHIELD
858113OtherARAZ
MN36-04052OtherMEDICA-PRIMARY
MN462327400Medicaid