Provider Demographics
NPI:1851398291
Name:JUDGE, CONSTANCE M (MD)
Entity Type:Individual
Prefix:DR
First Name:CONSTANCE
Middle Name:M
Last Name:JUDGE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:CONSTANCE
Other - Middle Name:M
Other - Last Name:PALLANTE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:35010 CHARDON RD
Mailing Address - Street 2:SUITE 205
Mailing Address - City:WILLOUGHBY
Mailing Address - State:OH
Mailing Address - Zip Code:44094-9010
Mailing Address - Country:US
Mailing Address - Phone:440-918-0501
Mailing Address - Fax:440-918-0525
Practice Address - Street 1:35010 CHARDON RD
Practice Address - Street 2:SUITE 205
Practice Address - City:WILLOUGHBY
Practice Address - State:OH
Practice Address - Zip Code:44094-9010
Practice Address - Country:US
Practice Address - Phone:440-918-0501
Practice Address - Fax:440-918-0525
Is Sole Proprietor?:No
Enumeration Date:2005-06-30
Last Update Date:2020-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35066650J208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH144118001OtherCIGNA
OH341106740033OtherCARESOURCE
OH000000127389OtherANTHEM
OHR66650OtherSUMMA CARE
OH1385893OtherUNITED HEALTHCARE
OH5479089OtherAETNA
OH54514OtherQUAL CHOICE
OH71303OtherNATIONWIDE HEALTH PLANS
OH5479089OtherAETNA