Provider Demographics
NPI:1437173994
Name:NAVARRO, JUDITH TAN (MD)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:TAN
Last Name:NAVARRO
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 1:1448 MANOA RD
Mailing Address - Street 2:
Mailing Address - City:WYNNEWOOD
Mailing Address - State:PA
Mailing Address - Zip Code:19096-3502
Mailing Address - Country:US
Mailing Address - Phone:610-896-8026
Mailing Address - Fax:610-896-8026
Practice Address - Street 1:1448 MANOA RD
Practice Address - Street 2:
Practice Address - City:WYNNEWOOD
Practice Address - State:PA
Practice Address - Zip Code:19096-3502
Practice Address - Country:US
Practice Address - Phone:610-896-8026
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD066148L2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0017829200001Medicaid
PA0339835OtherBS NUMBER
PA0017829200001Medicaid