Provider Demographics
NPI:1851494470
Name:VANWOERT, JUDITH MARION (MD)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:MARION
Last Name:VANWOERT
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:PO BOX 610
Mailing Address - Street 2:1525 NEW SCOTLAND RD
Mailing Address - City:SLINGERLANDS
Mailing Address - State:NY
Mailing Address - Zip Code:12159
Mailing Address - Country:US
Mailing Address - Phone:518-439-1564
Mailing Address - Fax:518-439-1592
Practice Address - Street 1:1525 NEW SCOTLAND RD
Practice Address - Street 2:
Practice Address - City:SLINGERLANDS
Practice Address - State:NY
Practice Address - Zip Code:12159
Practice Address - Country:US
Practice Address - Phone:518-439-1564
Practice Address - Fax:518-439-1592
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2010-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY201845207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
56464CMedicare ID - Type Unspecified
G36084Medicare UPIN