Provider Demographics
NPI:1760484679
Name:SMALL, JUDITH ANN (MD)
Entity Type:Individual
Prefix:DR
First Name:JUDITH
Middle Name:ANN
Last Name:SMALL
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 1:490 E NORTH AVE
Mailing Address - Street 2:SUITE 107
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15212-4740
Mailing Address - Country:US
Mailing Address - Phone:412-359-3376
Mailing Address - Fax:412-359-5094
Practice Address - Street 1:490 E NORTH AVE
Practice Address - Street 2:SUITE 107
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15212-4740
Practice Address - Country:US
Practice Address - Phone:412-359-3376
Practice Address - Fax:412-359-5094
Is Sole Proprietor?:No
Enumeration Date:2005-08-11
Last Update Date:2015-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD026669E207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0008612600006Medicaid
WV3810010222Medicaid
PA0008612600006Medicaid
PA074786NHQMedicare PIN
PA070013947Medicare PIN
PAC29080Medicare UPIN