Provider Demographics
NPI:1427254721
Name:UGALE-WILSON, JUDITH MARIE (MD)
Entity type:Individual
Prefix:DR
First Name:JUDITH
Middle Name:MARIE
Last Name:UGALE-WILSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:JUDITH MARIE
Other - Middle Name:KATIGBAK
Other - Last Name:UGALE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 416457
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-6457
Mailing Address - Country:US
Mailing Address - Phone:844-362-1735
Mailing Address - Fax:973-290-7495
Practice Address - Street 1:100 MADISON AVE
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07960-6136
Practice Address - Country:US
Practice Address - Phone:973-971-7550
Practice Address - Fax:973-290-7364
Is Sole Proprietor?:No
Enumeration Date:2007-06-23
Last Update Date:2022-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301082671208000000X
NC2012-014732080P0203X
SC305612080P0203X
NJ25MA113291002080P0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0203XAllopathic & Osteopathic PhysiciansPediatricsPediatric Critical Care Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1427254721Medicaid
18500OtherEVOLUTIONS
SC9303224OtherAETNA
NC5909275Medicaid
SCAA26508552OtherMEDICARE PTAN
SC20077595OtherSELECT HEALTH
SC045OtherBCBS
206995OtherMEDCOST
NC1844DOtherBCBS NC
SC305618Medicaid
SC9303224OtherAETNA