Provider Demographics
NPI:1821327297
Name:MILDENBERG, BUDD (MD)
Entity Type:Individual
Prefix:
First Name:BUDD
Middle Name:
Last Name:MILDENBERG
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 1:865 WASHINGTON LN
Mailing Address - Street 2:
Mailing Address - City:RYDAL
Mailing Address - State:PA
Mailing Address - Zip Code:19046-2330
Mailing Address - Country:US
Mailing Address - Phone:215-886-6672
Mailing Address - Fax:
Practice Address - Street 1:865 WASHINGTON LN
Practice Address - Street 2:
Practice Address - City:RYDAL
Practice Address - State:PA
Practice Address - Zip Code:19046-2330
Practice Address - Country:US
Practice Address - Phone:215-886-6672
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-15
Last Update Date:2009-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD023969E208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAB41039Medicare UPIN