1114061454 NPI number — DR. SADEKA J JUDE MD

Table of content: DR. SADEKA J JUDE MD (NPI 1114061454)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114061454 NPI number — DR. SADEKA J JUDE MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JUDE
Provider First Name:
SADEKA
Provider Middle Name:
J
Provider Name Prefix Text:
DR.
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:
1114061454
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/07/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10403 HOSPITAL DR
Provider Second Line Business Mailing Address:
STE G4
Provider Business Mailing Address City Name:
CLINTON
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20735-3134
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-856-3019
Provider Business Mailing Address Fax Number:
301-856-9370

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4225 ALTAMONT PL
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
WHITE PLAINS
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20695-3063
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-870-9900
Provider Business Practice Location Address Fax Number:
301-870-6458
Provider Enumeration Date:
02/19/2007

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: 207V00000X , with the licence number:  D0069655 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1851473722 . This is a "MEDICAL & SURGICAL CLINICS GROUP NPI" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 624316 . This is a "HIGHMARK MEDICARE GROUP PIN" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".
  • Identifier: B776 . This is a "CAREFIRST OF DC GROUP" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".
  • Identifier: KR10 . This is a "HIGHMARK MEDICARE GROUP PIN" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: KR10ME . This is a "BCBS OF MARYLAND GROUP #" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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