Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0300X | Geriatric Medicine | 027376 | CT |
NPI | 1154327369 |
---|---|
Provider Name | Dr. James E Judge |
First Address | Farmington, CT 06032-1114 |
Second Address | Farmington, CT 06032-1114 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/06/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D74033 | (02) | CT |