Provider Demographics
NPI:1093823254
Name:STANTON, JUDITH A (MD)
Entity type:Individual
Prefix:
First Name:JUDITH
Middle Name:A
Last Name:STANTON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3687 MT DIABLO BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:CA
Mailing Address - Zip Code:94549-3746
Mailing Address - Country:US
Mailing Address - Phone:916-854-6975
Mailing Address - Fax:
Practice Address - Street 1:2450 ASHBY AVE RM 5505
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94705-2067
Practice Address - Country:US
Practice Address - Phone:510-204-4444
Practice Address - Fax:510-649-8287
Is Sole Proprietor?:No
Enumeration Date:2006-08-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA78489208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA78489OtherSTATE LICENSE
I38692Medicare UPIN
00A784892Medicare ID - Type Unspecified