Provider Demographics
NPI:1770630691
Name:DUDA, ROGER H (MD)
Entity Type:Individual
Prefix:
First Name:ROGER
Middle Name:H
Last Name:DUDA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2451 MIDTOWN AVE APT 1327
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22303-1438
Mailing Address - Country:US
Mailing Address - Phone:610-999-6174
Mailing Address - Fax:
Practice Address - Street 1:2451 MIDTOWN AVE APT 1327
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22303-1438
Practice Address - Country:US
Practice Address - Phone:610-999-6174
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2016-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD4318322084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry