1396781712 NPI number — JUDY B DAVIDOFF M.D.

Table of content: JUDY B DAVIDOFF M.D. (NPI 1396781712)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396781712 NPI number — JUDY B DAVIDOFF M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DAVIDOFF
Provider First Name:
JUDY
Provider Middle Name:
B
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1396781712
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/18/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1111 N. CHARLES ST.
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BALTIMORE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21201-5403
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-837-2050
Provider Business Mailing Address Fax Number:
410-837-2071

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8507 LIBERTY RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RANDALLSTOWN
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21133-4819
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-496-6441
Provider Business Practice Location Address Fax Number:
410-496-6448
Provider Enumeration Date:
06/22/2006

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: 207Q00000X , with the licence number:  D0052384 , 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: 132190100 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".




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