Provider Demographics
NPI:1447242474
Name:WOLLMAN, JUDITH CAROL (MD)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:CAROL
Last Name:WOLLMAN
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 1:1401 FOULK ROAD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19803-2764
Mailing Address - Country:US
Mailing Address - Phone:302-478-5650
Mailing Address - Fax:302-477-0455
Practice Address - Street 1:1401 FOULK ROAD
Practice Address - Street 2:SUITE 202
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19803-2764
Practice Address - Country:US
Practice Address - Phone:302-478-5650
Practice Address - Fax:302-477-0455
Is Sole Proprietor?:No
Enumeration Date:2005-08-16
Last Update Date:2013-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC10001849207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
B66442Medicare UPIN
DEG02363B02Medicare Oscar/Certification