Provider Demographics
NPI:1326110255
Name:ANDERSON, JUDY MILLSPAUGH (MD)
Entity Type:Individual
Prefix:
First Name:JUDY
Middle Name:MILLSPAUGH
Last Name:ANDERSON
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 1:1205 CHRISTIAN ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19147-3611
Mailing Address - Country:US
Mailing Address - Phone:215-901-5022
Mailing Address - Fax:
Practice Address - Street 1:1829 BUSTLETON PIKE
Practice Address - Street 2:
Practice Address - City:FEASTERVILLE TREVOSE
Practice Address - State:PA
Practice Address - Zip Code:19053-7309
Practice Address - Country:US
Practice Address - Phone:215-364-8412
Practice Address - Fax:215-364-8730
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD039531L208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAF99318Medicare UPIN
047067Medicare ID - Type UnspecifiedPROF. CORP. MEDICARE NUMB
086245Medicare ID - Type UnspecifiedPERSONAL MEDICARE PROVIDE