1093991275 NPI number — JUDY KO MD

Table of content: JUDY KO MD (NPI 1093991275)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093991275 NPI number — JUDY KO MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KO
Provider First Name:
JUDY
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1093991275
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/08/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 388
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FISHERSVILLE
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22939-0388
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
540-932-5162
Provider Business Mailing Address Fax Number:
540-932-5875

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
30 GREENHOUSE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEXINGTON
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
24450-3789
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
540-464-3465
Provider Business Practice Location Address Fax Number:
540-464-3466
Provider Enumeration Date:
01/17/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RR0500X , with the licence number:  0101257891 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1093991275 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".




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