Provider Demographics
NPI:1619137569
Name:EDIAE, JUDE O (MD)
Entity Type:Individual
Prefix:DR
First Name:JUDE
Middle Name:O
Last Name:EDIAE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:750 KINGS HWY STE 105
Mailing Address - Street 2:
Mailing Address - City:LEWES
Mailing Address - State:DE
Mailing Address - Zip Code:19958-1772
Mailing Address - Country:US
Mailing Address - Phone:302-200-7530
Mailing Address - Fax:302-200-7966
Practice Address - Street 1:750 KINGS HWY STE 105
Practice Address - Street 2:
Practice Address - City:LEWES
Practice Address - State:DE
Practice Address - Zip Code:19958-1772
Practice Address - Country:US
Practice Address - Phone:302-200-7530
Practice Address - Fax:302-200-7966
Is Sole Proprietor?:No
Enumeration Date:2008-06-13
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD437515207R00000X
DEC1-0009131207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE165887ZEZBMedicare PIN