Provider Demographics
NPI:1770521957
Name:KING, JUDY A (MD)
Entity type:Individual
Prefix:
First Name:JUDY
Middle Name:A
Last Name:KING
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 1:1 MEDICAL CENTER DRIVE
Mailing Address - Street 2:HEALTH SCIENCES CENTER
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26506-9203
Mailing Address - Country:US
Mailing Address - Phone:304-293-5415
Mailing Address - Fax:304-293-1627
Practice Address - Street 1:1 MEDICAL CENTER DRIVE
Practice Address - Street 2:HEALTH SCIENCES CENTER
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26506-9203
Practice Address - Country:US
Practice Address - Phone:304-293-5415
Practice Address - Fax:304-293-1627
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2016-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL17704207ZP0102X
WV23471207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000026229Medicaid
MS00125247Medicaid
FL255641300Medicaid
AL510269229OtherBLUE CROSS
AL11-10267OtherUNITED HEALTH CARE
AL510269229OtherBLUE CROSS
AL11-10267OtherUNITED HEALTH CARE
AL000026229Medicaid
KI7393971Medicare PIN
KI4277641Medicare PIN