Provider Demographics
NPI:1902850332
Name:JUDKINS, JENNIFER H (MD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:H
Last Name:JUDKINS
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 1:106 HANOVER ST
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:NH
Mailing Address - Zip Code:03766-1042
Mailing Address - Country:US
Mailing Address - Phone:603-448-0447
Mailing Address - Fax:603-448-1089
Practice Address - Street 1:106 HANOVER ST
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:NH
Practice Address - Zip Code:03766-1042
Practice Address - Country:US
Practice Address - Phone:603-448-0447
Practice Address - Fax:603-448-1089
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH12996174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1012413Medicaid
NH30205893Medicaid
NHF96825Medicare UPIN
NH30205893Medicaid
NHRE8656Medicare PIN