Provider Demographics
NPI:1376768234
Name:CHUDOW, MICHELLE T (MD)
Entity type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:T
Last Name:CHUDOW
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 13579
Mailing Address - Street 2:
Mailing Address - City:READING
Mailing Address - State:PA
Mailing Address - Zip Code:19612-3579
Mailing Address - Country:US
Mailing Address - Phone:484-628-0797
Mailing Address - Fax:
Practice Address - Street 1:1708 W ROGERS AVE DEPT OF
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21209-4596
Practice Address - Country:US
Practice Address - Phone:410-578-5202
Practice Address - Fax:410-367-4196
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-16
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0068848208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics