Provider Demographics
NPI:1992978522
Name:PAUL A. TUDDER, M.D., F.A.C.O.G., P.C.
Entity type:Organization
Organization Name:PAUL A. TUDDER, M.D., F.A.C.O.G., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:CROSS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-777-6550
Mailing Address - Street 1:821 S KING ST
Mailing Address - Street 2:SUITE H
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20175-3921
Mailing Address - Country:US
Mailing Address - Phone:703-777-6550
Mailing Address - Fax:703-771-8021
Practice Address - Street 1:821 S KING ST
Practice Address - Street 2:SUITE H
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20175-3921
Practice Address - Country:US
Practice Address - Phone:703-777-6550
Practice Address - Fax:703-771-8021
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-03
Last Update Date:2009-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101033381207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
B09926Medicare UPIN