Provider Demographics
NPI:1740740539
Name:DUDEK, MAXINE (MD)
Entity Type:Individual
Prefix:
First Name:MAXINE
Middle Name:
Last Name:DUDEK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 HENRY ST
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05401-3329
Mailing Address - Country:US
Mailing Address - Phone:413-636-2319
Mailing Address - Fax:
Practice Address - Street 1:130 FISHER RD UNIT 1
Practice Address - Street 2:
Practice Address - City:BERLIN
Practice Address - State:VT
Practice Address - Zip Code:05602-8132
Practice Address - Country:US
Practice Address - Phone:802-371-4316
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-20
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT042.00170612084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry