Individual
DR. JUDITH PROPHETE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
5000 PARKSIDE AVE, PHILADELPHIA, PA 19131-4714
(732) 979-5810
Mailing address
5000 PARKSIDE AVE, PHILADELPHIA, PA 19131-4714
(732) 979-5810
Taxonomy
Speciality
Code
Description
License number
State
207QA0401X
Addiction Medicine (Family Medicine) Physician
Primary
MD 043080E
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
725985
—
PA
Enumeration date
02/06/2008
Last updated
02/06/2008
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