Basic Information
| Provider Information | |||||||||
| NPI: | 1558334441 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GRACIA | ||||||||
| FirstName: | JUDITH | ||||||||
| MiddleName: | NADINE | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 100 N 20TH ST | ||||||||
| Address2: | CHCA | ||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191031443 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2155672422 | ||||||||
| FaxNumber: | 2155610959 | ||||||||
| Practice Location | |||||||||
| Address1: | 34TH & CIVIC CENTER BLVD | ||||||||
| Address2: | CHILDREN'S HOSPITAL OF PHILADELPHIA | ||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 19104 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2155901000 | ||||||||
| FaxNumber: | 2155610959 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/10/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | MD426475 | PA | X | Other Service Providers | Specialist | 208000000X | MD426475 | PA | X | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.