Provider Demographics
NPI:1609932409
Name:DEBOSE, JUDITH FRANCIS (MD)
Entity Type:Individual
Prefix:DR
First Name:JUDITH
Middle Name:FRANCIS
Last Name:DEBOSE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:JUDITH
Other - Middle Name:
Other - Last Name:FRANCIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1001 E FAYETTE ST
Mailing Address - Street 2:BUREAU OF SCHOOL HEALTH
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21202-4715
Mailing Address - Country:US
Mailing Address - Phone:410-396-4453
Mailing Address - Fax:410-545-6636
Practice Address - Street 1:1001 E FAYETTE ST
Practice Address - Street 2:BCHD BUREAU OF SCHOOL HEALTH
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21202-4715
Practice Address - Country:US
Practice Address - Phone:410-396-4453
Practice Address - Fax:410-545-6636
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2022-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036114373208000000X
DCMD037748208000000X
MDD68520208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036114373Medicaid
I40643Medicare UPIN