Provider Demographics
NPI:1831260108
Name:KELLMAN, JUDITH D (MD)
Entity type:Individual
Prefix:DR
First Name:JUDITH
Middle Name:D
Last Name:KELLMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:DEPT 34929
Mailing Address - Street 2:P.O. BOX 39000
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94139-0001
Mailing Address - Country:US
Mailing Address - Phone:925-952-2828
Mailing Address - Fax:925-952-2850
Practice Address - Street 1:140 BROOKWOOD RD STE 201
Practice Address - Street 2:
Practice Address - City:ORINDA
Practice Address - State:CA
Practice Address - Zip Code:94563-3047
Practice Address - Country:US
Practice Address - Phone:925-254-9090
Practice Address - Fax:925-254-4399
Is Sole Proprietor?:No
Enumeration Date:2006-11-10
Last Update Date:2013-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG19603207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA40697Medicare UPIN
CA00G196031Medicare ID - Type Unspecified
CAHH739ZMedicare PIN