Provider Demographics
NPI:1801173703
Name:KILPATRICK, JUDITH HERRMAN (PA-C)
Entity type:Individual
Prefix:
First Name:JUDITH
Middle Name:HERRMAN
Last Name:KILPATRICK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8630 FENTON ST STE 1204
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910-3806
Mailing Address - Country:US
Mailing Address - Phone:301-340-7525
Mailing Address - Fax:240-499-2602
Practice Address - Street 1:8630 FENTON ST STE 1204
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-3806
Practice Address - Country:US
Practice Address - Phone:301-340-7525
Practice Address - Fax:240-499-2602
Is Sole Proprietor?:No
Enumeration Date:2011-11-07
Last Update Date:2015-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0004381363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant