Provider Demographics
NPI:1093877664
Name:JUDSON, KURT LAWRENCE (PA-C)
Entity Type:Individual
Prefix:MR
First Name:KURT
Middle Name:LAWRENCE
Last Name:JUDSON
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:57 WATER ST
Mailing Address - Street 2:
Mailing Address - City:BLUE HILL
Mailing Address - State:ME
Mailing Address - Zip Code:04614-5231
Mailing Address - Country:US
Mailing Address - Phone:207-374-3943
Mailing Address - Fax:207-374-3978
Practice Address - Street 1:57 WATER ST
Practice Address - Street 2:
Practice Address - City:BLUE HILL
Practice Address - State:ME
Practice Address - Zip Code:04614-5231
Practice Address - Country:US
Practice Address - Phone:207-374-3943
Practice Address - Fax:207-374-3978
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2020-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPA1991363A00000X
WAPA10005149363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME1093877664Medicaid
WA8476137Medicaid