Provider Demographics
NPI:1801065545
Name:MOLLY S JUDGE DPM
Entity type:Organization
Organization Name:MOLLY S JUDGE DPM
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MOLLY
Authorized Official - Middle Name:S
Authorized Official - Last Name:JUDGE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:419-732-2618
Mailing Address - Street 1:530 WASHINGTON STREET
Mailing Address - Street 2:
Mailing Address - City:PORT CLINTON
Mailing Address - State:OH
Mailing Address - Zip Code:43452-1935
Mailing Address - Country:US
Mailing Address - Phone:419-732-2618
Mailing Address - Fax:419-732-1998
Practice Address - Street 1:530 WASHINGTON STREET
Practice Address - Street 2:
Practice Address - City:PORT CLINTON
Practice Address - State:OH
Practice Address - Zip Code:43452-1935
Practice Address - Country:US
Practice Address - Phone:419-732-2618
Practice Address - Fax:419-732-1998
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-27
Last Update Date:2012-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2877213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000142130OtherANTHEMBCBS
OH2019774Medicaid
MI4855810540OtherBCBS MI
MI134887318Medicaid
OH4750850001Medicare NSC
OH0826573Medicare PIN
MI4855810540OtherBCBS MI
OH480030118Medicare PIN
OH0826574Medicare PIN