Provider Demographics
NPI:1588605232
Name:TAGOE, UDELE JOYCE (MD)
Entity Type:Individual
Prefix:
First Name:UDELE
Middle Name:JOYCE
Last Name:TAGOE
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:PO BOX 8500-6335
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19178-6335
Mailing Address - Country:US
Mailing Address - Phone:215-612-4143
Mailing Address - Fax:215-612-4909
Practice Address - Street 1:3998 RED LION RD
Practice Address - Street 2:SUITE 106
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19114-1445
Practice Address - Country:US
Practice Address - Phone:215-612-4143
Practice Address - Fax:215-612-4909
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2015-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD428204207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1020328930003Medicaid
PA1901845OtherHIGHMARK BLUE SHIELD
PA2768766000OtherKEYSTONE IBC
PA30171550OtherKEYSTONE FIRST
PA336613OtherAETNA
PA113522QRKMedicare PIN