Provider Demographics
NPI:1306827241
Name:CUDKOWICZ, MERIT ESTER (MD)
Entity Type:Individual
Prefix:DR
First Name:MERIT
Middle Name:ESTER
Last Name:CUDKOWICZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 9142
Mailing Address - Street 2:
Mailing Address - City:CHARLESTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02129-9142
Mailing Address - Country:US
Mailing Address - Phone:617-724-3914
Mailing Address - Fax:617-726-5346
Practice Address - Street 1:15 PARKMAN ST
Practice Address - Street 2:WAC 836
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-3117
Practice Address - Country:US
Practice Address - Phone:617-724-1873
Practice Address - Fax:617-724-7290
Is Sole Proprietor?:No
Enumeration Date:2005-11-08
Last Update Date:2012-07-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA791672084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3151484Medicaid
MA724886OtherTUFTS HEALTH PLAN
MAJ31960OtherBCBS MA
MA724886OtherTUFTS HEALTH PLAN
MAJ31960OtherBCBS MA