Provider Demographics
NPI:1396781712
Name:DAVIDOFF, JUDY B (MD)
Entity type:Individual
Prefix:
First Name:JUDY
Middle Name:B
Last Name:DAVIDOFF
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 1:1111 N. CHARLES ST.
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21201-5403
Mailing Address - Country:US
Mailing Address - Phone:410-837-2050
Mailing Address - Fax:410-837-2071
Practice Address - Street 1:8507 LIBERTY RD
Practice Address - Street 2:
Practice Address - City:RANDALLSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21133-4819
Practice Address - Country:US
Practice Address - Phone:410-496-6441
Practice Address - Fax:410-496-6448
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2013-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0052384207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD132190100Medicaid
MD211850Medicare Oscar/Certification
MD925XMedicare PIN
MDG53634Medicare UPIN
MDK802Medicare PIN