Provider Demographics
NPI:1396373023
Name:KUDRNA, JEREMY JAMES (MD, MS)
Entity type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:JAMES
Last Name:KUDRNA
Suffix:
Gender:M
Credentials:MD, MS
Other - Prefix:
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Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:500 UNIVERSITY DR
Mailing Address - Street 2:
Mailing Address - City:HERSHEY
Mailing Address - State:PA
Mailing Address - Zip Code:17033-2360
Mailing Address - Country:US
Mailing Address - Phone:717-531-1368
Mailing Address - Fax:717-531-2077
Practice Address - Street 1:1 GUTHRIE SQ
Practice Address - Street 2:
Practice Address - City:SAYRE
Practice Address - State:PA
Practice Address - Zip Code:18840-1699
Practice Address - Country:US
Practice Address - Phone:570-888-6666
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-30
Last Update Date:2024-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
PAMD485290207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program