Provider Demographics
NPI:1982643771
Name:DUDKOWSKA, BOGUSLAWA GRAZYNA (MD)
Entity Type:Individual
Prefix:
First Name:BOGUSLAWA
Middle Name:GRAZYNA
Last Name:DUDKOWSKA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:41 UNIVERSITY DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:NEWTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18940-1873
Mailing Address - Country:US
Mailing Address - Phone:215-710-5522
Mailing Address - Fax:215-710-5181
Practice Address - Street 1:735 DAVISVILLE RD STE 2B
Practice Address - Street 2:
Practice Address - City:SOUTHAMPTON
Practice Address - State:PA
Practice Address - Zip Code:18966
Practice Address - Country:US
Practice Address - Phone:215-396-4227
Practice Address - Fax:215-396-2523
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2018-08-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMD065061L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA020093OtherRAILROAD MEDICARE
PA0327063000OtherINDEPENDENCE BLUE CROSS
PA3064040OtherAETNA
PA30015328OtherKEYSTONE MERCY
PA422146OtherHIGHMARK BLUE SHIELD
PA0327063000OtherINDEPENDENCE BLUE CROSS
PAG81087Medicare UPIN