Provider Demographics
NPI:1891812863
Name:FUDALA, MARIA L (PA)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:L
Last Name:FUDALA
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Gender:F
Credentials:PA
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Mailing Address - Street 1:545 W GERMANTOWN PIKE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PLYMOUTH MEETING
Mailing Address - State:PA
Mailing Address - Zip Code:19462-1349
Mailing Address - Country:US
Mailing Address - Phone:484-351-8268
Mailing Address - Fax:484-351-8275
Practice Address - Street 1:545 W GERMANTOWN PIKE
Practice Address - Street 2:SUITE 100
Practice Address - City:PLYMOUTH MEETING
Practice Address - State:PA
Practice Address - Zip Code:19462-1349
Practice Address - Country:US
Practice Address - Phone:484-351-8268
Practice Address - Fax:484-351-8275
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2019-03-19
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Provider Licenses
StateLicense IDTaxonomies
PAMA051378363AS0400X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical