Provider Demographics
NPI:1679669931
Name:TUDDENHAM, ANN DAVINA (MD)
Entity Type:Individual
Prefix:DR
First Name:ANN
Middle Name:DAVINA
Last Name:TUDDENHAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 SHUMAN AVE
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:ME
Mailing Address - Zip Code:04330-6020
Mailing Address - Country:US
Mailing Address - Phone:855-239-3556
Mailing Address - Fax:207-502-1138
Practice Address - Street 1:12 SHUMAN AVE
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:ME
Practice Address - Zip Code:04330-6020
Practice Address - Country:US
Practice Address - Phone:855-239-3556
Practice Address - Fax:207-502-1138
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2018-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME014495208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME26888099Medicaid
G78705Medicare UPIN
G78705Medicare UPIN