Provider Demographics
NPI:1770732349
Name:FUDGE, KIM LOUISE (PA-C)
Entity type:Individual
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First Name:KIM
Middle Name:LOUISE
Last Name:FUDGE
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Gender:F
Credentials:PA-C
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Mailing Address - Street 1:ERIE AVE AT FRONT ST
Mailing Address - Street 2:ST CHRISTOPHERS HOSPITAL FOR CHILDREN
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19027-1095
Mailing Address - Country:US
Mailing Address - Phone:215-427-8190
Mailing Address - Fax:215-427-4638
Practice Address - Street 1:ERIE AVE AT FRONT ST
Practice Address - Street 2:ST CHRISTOPHER'S HOSPITAL FOR CHILDREN
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19134
Practice Address - Country:US
Practice Address - Phone:215-427-8190
Practice Address - Fax:215-427-4638
Is Sole Proprietor?:No
Enumeration Date:2008-09-18
Last Update Date:2024-05-21
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Provider Licenses
StateLicense IDTaxonomies
PAMA-002885-L363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant