Provider Demographics
NPI:1952153512
Name:MATHESS, JUDITH MAKENZIE (MD (APRIL 28,2024))
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:MAKENZIE
Last Name:MATHESS
Suffix:
Gender:F
Credentials:MD (APRIL 28,2024)
Other - Prefix:
Other - First Name:JUDITH
Other - Middle Name:MAKENZIE
Other - Last Name:CLARK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1 WYOMING STREET,
Mailing Address - Street 2:BG020
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45409
Mailing Address - Country:US
Mailing Address - Phone:419-560-6655
Mailing Address - Fax:
Practice Address - Street 1:1 WYOMING STREET
Practice Address - Street 2:BG020
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45409
Practice Address - Country:US
Practice Address - Phone:419-560-6655
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-04
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program