Basic Information
| Provider Information | |||||||||
| NPI: | 1013237916 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JUDD | ||||||||
| FirstName: | MARY | ||||||||
| MiddleName: | JENNETTE | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 600 GREEN VALLEY RD STE 304 | ||||||||
| Address2: | |||||||||
| City: | GREENSBORO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 274087722 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3362824840 | ||||||||
| FaxNumber: | 3362824660 | ||||||||
| Practice Location | |||||||||
| Address1: | 600 GREEN VALLEY RD STE 304 | ||||||||
| Address2: | |||||||||
| City: | GREENSBORO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 274087722 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3362824840 | ||||||||
| FaxNumber: | 3362824660 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/03/2010 | ||||||||
| LastUpdateDate: | 08/18/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 51542 | TN | N | Allopathic & Osteopathic Physicians | Anesthesiology | 390200000X | 165137 | NC | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207L00000X | 2015-00730 | NC | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.