Individual
MR. TOM ALAN JUDY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
10130 PERIMETER PKWY, STE 200, CHARLOTTE, NC 28216-2447
(888) 849-7379
(855) 857-7333
Mailing address
10130 PERIMETER PKWY, STE 200, CHARLOTTE, NC 28216-2447
(888) 849-7379
(855) 857-7333
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
015190
NY
363A00000X
Physician Assistant
50003018
OH
363AM0700X
Medical Physician Assistant
Primary
10-95
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
POO864679
MEDICARE RR
OH
Enumeration date
07/10/2006
Last updated
02/10/2017
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