Provider Demographics
NPI:1972641801
Name:MASCOLO, JUDITH M (MD)
Entity type:Individual
Prefix:DR
First Name:JUDITH
Middle Name:M
Last Name:MASCOLO
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:639 PARK RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06107-3443
Mailing Address - Country:US
Mailing Address - Phone:860-233-4600
Mailing Address - Fax:860-233-4604
Practice Address - Street 1:639 PARK RD
Practice Address - Street 2:SUITE 100
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06107-3443
Practice Address - Country:US
Practice Address - Phone:860-233-4600
Practice Address - Fax:860-233-4604
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-02
Last Update Date:2014-04-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CT036592207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine