Provider Demographics
NPI:1518126531
Name:JUDELMAN, KEVIN MARC (MD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:MARC
Last Name:JUDELMAN
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 1:1307 FEDERAL ST
Mailing Address - Street 2:SUITE B300
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15212-4769
Mailing Address - Country:US
Mailing Address - Phone:412-359-3751
Mailing Address - Fax:412-359-8439
Practice Address - Street 1:1307 FEDERAL ST
Practice Address - Street 2:SUITE B300
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15212-4769
Practice Address - Country:US
Practice Address - Phone:412-359-3751
Practice Address - Fax:412-359-8439
Is Sole Proprietor?:No
Enumeration Date:2008-06-05
Last Update Date:2010-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD434806207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1021794000001Medicaid
PAP00629744OtherMEDICARE RAILROAD
PA130278NJKMedicare PIN