KENNETH G JUDSON DO, NPI 1770525891 — CUMBERLAND (MD)

NPI 1770525891

13+ Years Experience Individual

KENNETH G JUDSON DO

06.12.2006
PROVIDER ENUMERATION DATE
01.05.2016
LAST UPDATE DATE
1770525891
NPI NUMBER

About KENNETH G JUDSON

Sole proprietor? No, Entity Type 1 Provider (Individual) is not a Sole Proprietor.

KENNETH G JUDSON is a provider established in CUMBERLAND, MD. The NPI number of KENNETH G JUDSON is 1770525891 and was assigned on 06.12.2006. The practitioners primary taxonomy code is: 207RC0000X with license number: OS010445L PA .

Mailing address

  • City: CUMBERLAND
  • State: MD
  • Postal code: 215026491
  • Phone: 2409648740
  • Fax: 2409648741
  • Address: 12502 WILLOWBROOK RD
  • Address 2: SUITE 400

Primary Practice Address

  • Region : CUMBERLAND, MD
  • NPI : 1770525891
  • Phone : 2409648740
  • Fax : 2409648741
  • Postalcode : 215026491
  • Address : 12502 WILLOWBROOK RD SUITE 400

Additional identifiers

  • Identifier: 2670622
  • Code / Type : 5 - MEDICAID
  • Identifier state : OH

Additional identifier(s) currently or formerly used as an identifier for the provider. The codes may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.

Additional identifiers # 2

  • Identifier: 2670622
  • Code / Type : 5 - MEDICAID
  • Identifier state : WV

Provider taxonomy - Internal Medicine

  • Taxonomy code: 207RC0000X
  • License number: OS010445L
  • License state: PA

The taxonomy is not the primary taxonomy.

Taxonomy description: An internist who specializes in diseases of the heart and blood vessels and manages complex cardiac conditions such as heart attacks and life-threatening, abnormal heartbeat rhythms.

Healthcare provider taxonomy #2 - Internal Medicine

  • Taxonomy code: 207RC0001X
  • License number: OS010445L
  • License state: PA

The taxonomy is the primary taxonomy (there can be only one per NPI record).

Taxonomy description: A field of special interest within the subspecialty of cardiovascular disease, specialty of Internal Medicine, which involves intricate technical procedures to evaluate heart rhythms and determine appropriate treatment for them.

Contacts:

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  • KENNETH G JUDSON DO
  • Address : 12502 WILLOWBROOK RD SUITE 400
  • Region : CUMBERLAND, MD
  • NPI : 1770525891
  • Phone : 2409648740
  • Fax : 2409648741
  • Postalcode : 215026491

Reference NPI Information. Full replica of the CMS (NPPES) NPI record

Field Name Value
Provider First Line Business Practice Location Address12502 WILLOWBROOK RD
The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Second Line Business Practice Location AddressSUITE 400
The second line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Business Practice Location Address City NameCUMBERLAND
The city name in the location address of the provider being identified.
Provider Business Practice Location Address State NameMD
The State or Province name in the location address of the provider being identified.
Provider Business Practice Location Address Postal Code215026491
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
Provider Business Practice Location Address Telephone Number2409648740
The telephone number associated with the location address of the provider being identified.
Provider Business Practice Location Address Fax Number2409648741
The fax number associated with the location address of the provider being identified.
NPI1770525891
10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider.
Healthcare Provider Taxonomy 1207RC0000X
An internist who specializes in diseases of the heart and blood vessels and manages complex cardiac conditions such as heart attacks and life-threatening, abnormal heartbeat rhythms.
Provider Enumeration Date06.12.2006
The date the provider was assigned a unique identifier (assigned an NPI).
Last Updated01.05.2016
The date that a record was last updated or changed.
Entity TypeIndividual
Code describing the type of health care provider that is being assigned an NPI. Codes are:
  • 1 = (Person): individual human being who furnishes health care;
  • 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
Provider Organization Name (Legal Business Name)KENNETH G JUDSON
Provide organization name (legal business name used to file tax returns with the IRS). The Organization Name field allows the following special characters: ampersand, apostrophe, "at" sign, colon, comma, forward slash, hyphen, left and right parentheses, period, pound sign, quotation mark, and semi-colon. A field cannot contain all special characters.
Provider First Line Business Mailing Address12502 WILLOWBROOK RD
The first line mailing address of the provider being identified. This data element may contain the same information as "Provider first line location address".
Provider Second Line Business Mailing AddressSUITE 400
The second line mailing address of the provider being identified. This data element may contain the same information as "Provider second line location address".
Provider Business Mailing Address City NameCUMBERLAND
The City name in the mailing address of the provider being identified. This data element may contain the same information as "Provider location address City name".
Provider Business Mailing Address State NameMD
The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as "Provider location address State name".
Provider Business Mailing Address Postal Code215026491
The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as "Provider location address postal code".
Provider Business Mailing Address Telephone Number2409648740
The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as "Provider location address telephone number".
Provider Business Mailing Address Fax Number2409648741
The fax number associated with the mailing address of the provider being identified. This data element may contain the same information as "Provider location address fax number".
Healthcare Provider Taxonomy Code #1207RC0000X
The Health Care Provider Taxonomy code is a unique alphanumeric code, ten characters in length. The code set is structured into three distinct "Levels" including Provider Type, Classification, and Area of Specialization.
Healthcare Provider Taxonomy 1Internal Medicine
An internist who specializes in diseases of the heart and blood vessels and manages complex cardiac conditions such as heart attacks and life-threatening, abnormal heartbeat rhythms.
Provider License Number 1OS010445L
Certain taxonomy selections will require you to enter your license number and the state where the license was issued. Select Foreign Country in the state drop down box if the license was issued outside of United States. The License Number field allows the following special characters: ampersand, apostrophe, colon, comma, forward slash, hyphen, left and right parentheses, period, pound sign, quotation mark, and semi-colon. A field cannot contain all special characters. DO NOT report the Social Security Number (SSN), IRS Individual Taxpayer Identification Number (ITIN) in this section.
Provider License Number State Code 1PA
Healthcare Provider Primary Taxonomy Switch 1N
Primary Taxonomy:
  • X - The primary taxonomy switch is Not Answered;
  • Y - The taxonomy is the primary taxonomy (there can be only one per NPI record);
  • N - The taxonomy is not the primary taxonomy.
Healthcare Provider Taxonomy Code 2207RC0001X
Healthcare Provider Taxonomy 2Internal Medicine
A field of special interest within the subspecialty of cardiovascular disease, specialty of Internal Medicine, which involves intricate technical procedures to evaluate heart rhythms and determine appropriate treatment for them.
Provider License Number 2OS010445L
Certain taxonomy selections will require you to enter your license number and the state where the license was issued. Select Foreign Country in the state drop down box if the license was issued outside of United States. The License Number field allows the following special characters: ampersand, apostrophe, colon, comma, forward slash, hyphen, left and right parentheses, period, pound sign, quotation mark, and semi-colon. A field cannot contain all special characters. DO NOT report the Social Security Number (SSN), IRS Individual Taxpayer Identification Number (ITIN) in this section.
Provider License Number State Code 2PA
Healthcare Provider Primary Taxonomy Switch 2Y
Primary Taxonomy:
  • X - The primary taxonomy switch is Not Answered;
  • Y - The taxonomy is the primary taxonomy (there can be only one per NPI record);
  • N - The taxonomy is not the primary taxonomy.
Other Provider Identifier 12670622
Other Provider Identifier #1
Other Provider Identifier Type 15
  • 1 - Other
  • 5 - MEDICAID
Other Provider Identifier State 1OH
Other Provider Identifier State #1
Other Provider Identifier 22670622
Other Provider Identifier #2
Other Provider Identifier Type 25
  • 1 - Other
  • 5 - MEDICAID
Other Provider Identifier State 2WV
Other Provider Identifier State #2
Provider Gender CodeM
  • M - male
  • F - female
Is sole proprietorN
  • X - Not Answered
  • Y - Yes, Entity Type 1 Provider (Individual) is a Sole Proprietor
  • N - No, Entity Type 1 Provider (Individual) is not a Sole Proprietor
X

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