Provider Demographics
NPI:1679589469
Name:YUDKOFF, MARC P (MD)
Entity Type:Individual
Prefix:
First Name:MARC
Middle Name:P
Last Name:YUDKOFF
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:100 E PENN SQ
Mailing Address - Street 2:9TH FLOOR
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-3323
Mailing Address - Country:US
Mailing Address - Phone:267-425-9232
Mailing Address - Fax:267-425-9299
Practice Address - Street 1:3401 CIVIC CENTER BLVD
Practice Address - Street 2:CHILDREN'S HOSPITAL OF PHILADELPHIA - METABOLISM
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-4319
Practice Address - Country:US
Practice Address - Phone:215-590-3376
Practice Address - Fax:215-590-4297
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2013-04-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMD017296E207SG0201X, 207SG0202X, 208000000X, 2080P0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207SG0201XAllopathic & Osteopathic PhysiciansMedical GeneticsClinical Genetics (M.D.)
No207SG0202XAllopathic & Osteopathic PhysiciansMedical GeneticsClinical Biochemical Genetics
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080P0006XAllopathic & Osteopathic PhysiciansPediatricsDevelopmental - Behavioral Pediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1518305Medicaid
PA000665026Medicaid
PA000665026Medicaid
B33849Medicare UPIN