Provider Demographics
NPI:1780610535
Name:GREM, JUDITH F (MD)
Entity type:Individual
Prefix:
First Name:JUDITH
Middle Name:F
Last Name:GREM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JUDITH
Other - Middle Name:
Other - Last Name:FONKEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:241 PEACE LN
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17112-8432
Mailing Address - Country:US
Mailing Address - Phone:717-599-5377
Mailing Address - Fax:
Practice Address - Street 1:ROUTE 422, SPORTSMAN ROAD
Practice Address - Street 2:BUILDING 37
Practice Address - City:WERNERSVILLE
Practice Address - State:PA
Practice Address - Zip Code:19565-0300
Practice Address - Country:US
Practice Address - Phone:610-678-3411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD020070E207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAF07653Medicare UPIN
699492Medicare PIN