Provider Demographics
NPI:1447393913
Name:FINE, JUDY S (MD)
Entity Type:Individual
Prefix:
First Name:JUDY
Middle Name:S
Last Name:FINE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JUDY
Other - Middle Name:S
Other - Last Name:FINE-EDELSTEIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:27 SADDLE CLUB RD
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02420-2121
Mailing Address - Country:US
Mailing Address - Phone:781-860-9009
Mailing Address - Fax:
Practice Address - Street 1:27 SADDLE CLUB RD
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:MA
Practice Address - Zip Code:02420-2121
Practice Address - Country:US
Practice Address - Phone:781-860-9009
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2012-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA733832084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3109267Medicaid
MA3109267Medicaid
MAF55022Medicare UPIN