Provider Demographics
NPI:1215927538
Name:SZULECKI, JUDITH MARIE (MD)
Entity type:Individual
Prefix:DR
First Name:JUDITH
Middle Name:MARIE
Last Name:SZULECKI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:JUDITH
Other - Middle Name:SZULECKI
Other - Last Name:BUNIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:209 CLEVELAND AVE
Mailing Address - Street 2:
Mailing Address - City:MARTINSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24112-3714
Mailing Address - Country:US
Mailing Address - Phone:276-632-6496
Mailing Address - Fax:276-632-6701
Practice Address - Street 1:312 FAIRY STREET EXT
Practice Address - Street 2:STE 201
Practice Address - City:MARTINSVILLE
Practice Address - State:VA
Practice Address - Zip Code:24112-1912
Practice Address - Country:US
Practice Address - Phone:276-632-6496
Practice Address - Fax:276-632-6701
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-27
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101023435207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA005949173Medicaid
VA001826OtherANTHEM
VAAS5902134OtherDEA #
VA005949173Medicaid
VA072915548Medicare ID - Type Unspecified