Basic Information
| Provider Information | |||||||||
| NPI: | 1760837827 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JUDGE | ||||||||
| FirstName: | CONOR | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 501 MADISON AVE | ||||||||
| Address2: | |||||||||
| City: | SCRANTON | ||||||||
| State: | PA | ||||||||
| PostalCode: | 185102401 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5703432383 | ||||||||
| FaxNumber: | 5703434800 | ||||||||
| Practice Location | |||||||||
| Address1: | 631 N BROAD STREET EXT | ||||||||
| Address2: | |||||||||
| City: | GROVE CITY | ||||||||
| State: | PA | ||||||||
| PostalCode: | 161274603 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7244507246 | ||||||||
| FaxNumber: | 7244507247 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/26/2016 | ||||||||
| LastUpdateDate: | 10/05/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 10/05/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | MT212008 | PA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.