Provider Demographics
NPI:1659056257
Name:JUDY, JON J (CSFA)
Entity Type:Individual
Prefix:
First Name:JON
Middle Name:J
Last Name:JUDY
Suffix:
Gender:M
Credentials:CSFA
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 4042
Mailing Address - Street 2:
Mailing Address - City:BROADLANDS
Mailing Address - State:VA
Mailing Address - Zip Code:20148-0003
Mailing Address - Country:US
Mailing Address - Phone:623-533-9733
Mailing Address - Fax:
Practice Address - Street 1:43169 GATWICK SQ
Practice Address - Street 2:
Practice Address - City:ASHBURN
Practice Address - State:VA
Practice Address - Zip Code:20147-4432
Practice Address - Country:US
Practice Address - Phone:623-533-9733
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-20
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical