Provider Demographics
NPI:1558594168
Name:KENNETH P. JUDD, M.D., PH.D. AND ASSOCIATES LLC
Entity Type:Organization
Organization Name:KENNETH P. JUDD, M.D., PH.D. AND ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE ORGANIZER
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:JUDD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-228-8106
Mailing Address - Street 1:100 BRAMBLE ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MD
Mailing Address - Zip Code:21613-2471
Mailing Address - Country:US
Mailing Address - Phone:410-228-8106
Mailing Address - Fax:410-228-8390
Practice Address - Street 1:100 BRAMBLE ST
Practice Address - Street 2:SUITE 1
Practice Address - City:CAMBRIDGE
Practice Address - State:MD
Practice Address - Zip Code:21613-2471
Practice Address - Country:US
Practice Address - Phone:410-228-8106
Practice Address - Fax:410-228-8390
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-30
Last Update Date:2009-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD22122207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty