Provider Demographics
NPI:1356318356
Name:GOULDIN, JUDITH ANN (MD)
Entity Type:Individual
Prefix:DR
First Name:JUDITH
Middle Name:ANN
Last Name:GOULDIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Suffix:
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Mailing Address - Street 1:1201 GRAMPIAN BLVD
Mailing Address - Street 2:PO BOX 3127
Mailing Address - City:WILLIAMSPORT
Mailing Address - State:PA
Mailing Address - Zip Code:17701-1900
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:777 RURAL AVE
Practice Address - Street 2:
Practice Address - City:WILLIAMSPORT
Practice Address - State:PA
Practice Address - Zip Code:17701-3109
Practice Address - Country:US
Practice Address - Phone:570-321-2400
Practice Address - Fax:570-321-2496
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2007-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD019724E207U00000X, 2085N0904X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207U00000XAllopathic & Osteopathic PhysiciansNuclear Medicine
No2085N0904XAllopathic & Osteopathic PhysiciansRadiologyNuclear Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0007802700001Medicaid
PA073898OtherHIGHMARK BLUE SHIELD
PA816713OtherFIRST PRIORITY HEALTH
PA561809OtherAETNA
PA4501OtherHEALTHAMERICA
PA1553604OtherUNITEDHEALTHCARE
PA078201OtherFIRST PRIORITY HEALTH
PA1553604OtherUNITEDHEALTHCARE
PA073898Medicare PIN