Provider Demographics
NPI:1588690556
Name:DUDA, JOHN R (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:R
Last Name:DUDA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 TOWNSHIP LINE RD
Mailing Address - Street 2:
Mailing Address - City:ELKINS PARK
Mailing Address - State:PA
Mailing Address - Zip Code:19027-2220
Mailing Address - Country:US
Mailing Address - Phone:215-663-6620
Mailing Address - Fax:215-663-6630
Practice Address - Street 1:60 TOWNSHIP LINE RD
Practice Address - Street 2:
Practice Address - City:ELKINS PARK
Practice Address - State:PA
Practice Address - Zip Code:19027-2220
Practice Address - Country:US
Practice Address - Phone:215-663-6620
Practice Address - Fax:215-663-6630
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD016741E174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000091229OtherHIGHMARK BLUE SHIELD
PA0052364000OtherHMO ID
PA2512889OtherUS HEALTHCARE
PA0006982880002Medicaid
PA0069828805OtherAMERICHOICE MEDICAID
PA1005357OtherKEYSTONE MERCY
PA990781OtherHEALTH PARTNERS
PA0069828805OtherAMERICHOICE MEDICAID
PA2512889OtherUS HEALTHCARE