Provider Demographics
NPI:1265433932
Name:IUDICA, ANTHONY CHRISTIAN (MD)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:CHRISTIAN
Last Name:IUDICA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1831 RESERVOIR ST
Mailing Address - Street 2:
Mailing Address - City:HARRISONBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22801-8743
Mailing Address - Country:US
Mailing Address - Phone:540-433-9151
Mailing Address - Fax:540-433-0547
Practice Address - Street 1:1831 RESERVOIR ST
Practice Address - Street 2:
Practice Address - City:HARRISONBURG
Practice Address - State:VA
Practice Address - Zip Code:22801-8743
Practice Address - Country:US
Practice Address - Phone:540-433-9151
Practice Address - Fax:540-433-0547
Is Sole Proprietor?:No
Enumeration Date:2005-08-03
Last Update Date:2013-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101223186207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA005619858Medicaid
VA005619858OtherVA PREMIER ID
VA113977OtherOPTIMA
VA145606OtherSOUTHERN HEALTH ID
VA453282OtherANTHEM ID
VA005619858Medicaid
VA005619858OtherVA PREMIER ID