Provider Demographics
NPI:1407945462
Name:JUDGE, THOMAS A (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:A
Last Name:JUDGE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 FELLOWSHIP RD
Mailing Address - Street 2:SUITE 101 (GASTROENTEROLOGY)
Mailing Address - City:MOUNT LAUREL
Mailing Address - State:NJ
Mailing Address - Zip Code:08054-3419
Mailing Address - Country:US
Mailing Address - Phone:856-642-2133
Mailing Address - Fax:856-642-2134
Practice Address - Street 1:501 FELLOWSHIP RD
Practice Address - Street 2:SUITE 101 (GASTROENTEROLOGY)
Practice Address - City:MOUNT LAUREL
Practice Address - State:NJ
Practice Address - Zip Code:08054-3419
Practice Address - Country:US
Practice Address - Phone:856-642-2133
Practice Address - Fax:856-642-2134
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2016-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA76060207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1000034276Medicaid
2214869000OtherAMERIHEALTH, KEYSTONE IBC
NJ6214401Medicaid
3252765OtherAETNA
60000191OtherHORIZON NJ HEALTH
P00105668OtherRR MEDICARE
3252765OtherAETNA
DEG01766C04Medicare PIN
NJ070921AVVMedicare PIN