Provider Demographics
NPI:1366547218
Name:JUDGE, JODY K (MD)
Entity type:Individual
Prefix:
First Name:JODY
Middle Name:K
Last Name:JUDGE
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 1:50 STANIFORD ST
Mailing Address - Street 2:SUITE 600
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02114-2517
Mailing Address - Country:US
Mailing Address - Phone:617-367-4800
Mailing Address - Fax:617-723-7028
Practice Address - Street 1:61 LINCOLN ST
Practice Address - Street 2:SUITE 212
Practice Address - City:FRAMINGHAM
Practice Address - State:MA
Practice Address - Zip Code:01702-8264
Practice Address - Country:US
Practice Address - Phone:508-875-9787
Practice Address - Fax:508-872-3472
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA80003207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1366547218OtherTUFTS HEALTH PLAN
MA110055330AMedicaid
MA3133800Medicaid
NX4585Medicare PIN
F 97251Medicare UPIN
MA1366547218OtherTUFTS HEALTH PLAN