Provider Demographics
NPI:1972612745
Name:WALL, JUDITH E (MD)
Entity type:Individual
Prefix:DR
First Name:JUDITH
Middle Name:E
Last Name:WALL
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Gender:F
Credentials:MD
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Mailing Address - Street 1:PO BOX 191
Mailing Address - Street 2:PROVIDER ENROLLMENT DEPT
Mailing Address - City:ROCKLAND
Mailing Address - State:DE
Mailing Address - Zip Code:19732-0191
Mailing Address - Country:US
Mailing Address - Phone:302-651-6212
Mailing Address - Fax:302-651-4945
Practice Address - Street 1:1717 S ORANGE AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-2944
Practice Address - Country:US
Practice Address - Phone:407-650-7000
Practice Address - Fax:407-650-7124
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2011-11-23
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Provider Licenses
StateLicense IDTaxonomies
FLME545642080P0207X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3205461Medicaid
FL373323800Medicaid
NJ6728804Medicaid
RIJW35718Medicaid
NY01602271Medicaid
NC7612489Medicaid
RIJW35718Medicaid
NC7612489Medicaid