Provider Demographics
NPI:1013943232
Name:FUDGE, JULIE L (MD)
Entity Type:Individual
Prefix:DR
First Name:JULIE
Middle Name:L
Last Name:FUDGE
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 1:370 WESTMINSTER RD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14607-3233
Mailing Address - Country:US
Mailing Address - Phone:585-224-1364
Mailing Address - Fax:
Practice Address - Street 1:370 WESTMINSTER RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14607-3233
Practice Address - Country:US
Practice Address - Phone:585-241-3648
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-23
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1848642084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01436593Medicaid
NY01436593Medicaid
NY39364VMedicare PIN