Provider Demographics
NPI:1699816827
Name:GATES, JUDITH ANN (PA-C)
Entity Type:Individual
Prefix:MS
First Name:JUDITH
Middle Name:ANN
Last Name:GATES
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6502 SMOKEHOUSE CT
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21045-4405
Mailing Address - Country:US
Mailing Address - Phone:410-955-7888
Mailing Address - Fax:410-955-0626
Practice Address - Street 1:JOHNS HOPKINS HOSPITAL,
Practice Address - Street 2:WOLFE ST., HARVEY 811
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21287-8811
Practice Address - Country:US
Practice Address - Phone:410-955-7888
Practice Address - Fax:410-955-0626
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0001325363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant