Provider Demographics
NPI:1578581377
Name:HIEMENGA, JUDITH A (MD)
Entity Type:Individual
Prefix:DR
First Name:JUDITH
Middle Name:A
Last Name:HIEMENGA
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 1:100 CAMPUS DR UNIT 121
Mailing Address - Street 2:
Mailing Address - City:SCARBOROUGH
Mailing Address - State:ME
Mailing Address - Zip Code:04074-7172
Mailing Address - Country:US
Mailing Address - Phone:207-396-7270
Mailing Address - Fax:207-396-7944
Practice Address - Street 1:100 CAMPUS DR UNIT 121
Practice Address - Street 2:
Practice Address - City:SCARBOROUGH
Practice Address - State:ME
Practice Address - Zip Code:04074-7172
Practice Address - Country:US
Practice Address - Phone:207-396-7270
Practice Address - Fax:207-396-7944
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2023-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIJH046477174400000X
MI4301046477207SG0201X, 207V00000X
VA0116021576390200000X
MEMD26771207SG0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207SG0201XAllopathic & Osteopathic PhysiciansMedical GeneticsClinical Genetics (M.D.)
No174400000XOther Service ProvidersSpecialist
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1839836Medicaid
MI1839836Medicaid