Provider Demographics
NPI:1336230135
Name:KLEPPEL, JUDY BETH (MD)
Entity type:Individual
Prefix:
First Name:JUDY
Middle Name:BETH
Last Name:KLEPPEL
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:PO BOX 177
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE HILL
Mailing Address - State:PA
Mailing Address - Zip Code:19444-0177
Mailing Address - Country:US
Mailing Address - Phone:610-834-6000
Mailing Address - Fax:610-834-4019
Practice Address - Street 1:521 PLYMOUTH RD
Practice Address - Street 2:SUITE 117
Practice Address - City:PLYMOUTH MEETING
Practice Address - State:PA
Practice Address - Zip Code:19462-1638
Practice Address - Country:US
Practice Address - Phone:610-834-6000
Practice Address - Fax:610-834-4019
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2010-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD041967E174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1147428Medicaid
PA546693OtherBLUE SHIELD
PA546693OtherBLUE SHIELD
PAE13017Medicare UPIN