Provider Demographics
NPI:1659352813
Name:FOKUM, JUDITH G (MD)
Entity Type:Individual
Prefix:DR
First Name:JUDITH
Middle Name:G
Last Name:FOKUM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:228 WINN ST
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01803-2630
Mailing Address - Country:US
Mailing Address - Phone:978-741-1200
Mailing Address - Fax:
Practice Address - Street 1:81 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:MA
Practice Address - Zip Code:01970-2714
Practice Address - Country:US
Practice Address - Phone:978-741-1200
Practice Address - Fax:978-741-1200
Is Sole Proprietor?:No
Enumeration Date:2005-11-07
Last Update Date:2007-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA219709207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA470051OtherTUFTS HEALTH PLAN
MA2074541Medicaid
MAJ27181OtherBCBS MA
MAJ27181OtherBCBS MA
MAA36682Medicare ID - Type Unspecified