Provider Demographics
NPI:1568469195
Name:ODENHEIMER, JUDITH B (MD)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:B
Last Name:ODENHEIMER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 9120
Mailing Address - Street 2:
Mailing Address - City:DEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02027-9120
Mailing Address - Country:US
Mailing Address - Phone:781-329-1400
Mailing Address - Fax:781-278-5667
Practice Address - Street 1:325 RIVER RIDGE DR
Practice Address - Street 2:
Practice Address - City:NORWOOD
Practice Address - State:MA
Practice Address - Zip Code:02062-5027
Practice Address - Country:US
Practice Address - Phone:781-329-1400
Practice Address - Fax:781-278-5667
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA49945208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
61030OtherHARVARD PILGRIM POS
J05387OtherBLUE SHIELD-INDEMNITY
J05387OtherBS-BLUE CARE ELECT
049945OtherTUFTS TOTAL HEALTH PLAN
D88418OtherFIRST SENIORITY
049945OtherTUFTS COMMONWEALTH PPO
3009203OtherMASS HEALTH (DIV OF MED S
049945OtherTUFTS BENEFIT ADMINSTRATO
2056039OtherHEALTHSOURCE MA
27616OtherCHILDREN'S MEDICAL SECURI
61030OtherHARVARD/PILGRIM
J05387OtherHMO BLUE/BLUE CHOICE
0016063OtherNEIGHBORHOOD HEALTH PLAN
049945OtherTUFTS
1240307OtherUNITED HEALTHCARE (PPO)
2056039OtherCIGNA HEALTH CARE
61030OtherHARVARD PILGRIM PPO
J05387OtherBS-BLUE CARE ELECT
D88418OtherFIRST SENIORITY