Provider Demographics
NPI:1982697793
Name:JUDE, COLLEEN D (MD)
Entity Type:Individual
Prefix:DR
First Name:COLLEEN
Middle Name:D
Last Name:JUDE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 838
Mailing Address - Street 2:
Mailing Address - City:LEONARDTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20650-0838
Mailing Address - Country:US
Mailing Address - Phone:301-475-6900
Mailing Address - Fax:240-256-8728
Practice Address - Street 1:23348 NICHOLSON ST
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:MD
Practice Address - Zip Code:20636-3287
Practice Address - Country:US
Practice Address - Phone:301-475-6900
Practice Address - Fax:240-256-8728
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-26
Last Update Date:2018-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD28544207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD756741300Medicaid
MD756741300Medicaid
F37318Medicare UPIN