Individual
UDELE JOYCE TAGOE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
3998 RED LION RD, SUITE 106, PHILADELPHIA, PA 19114-1445
(215) 612-4143
(215) 612-4909
Mailing address
PO BOX 8500-6335, PHILADELPHIA, PA 19178-6335
(215) 612-4143
(215) 612-4909
Taxonomy
Speciality
Code
Description
License number
State
207VG0400X
Gynecology Physician
Primary
MD428204
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1020328930003
—
PA
01
—
1901845
HIGHMARK BLUE SHIELD
PA
01
—
2768766000
KEYSTONE IBC
PA
01
—
30171550
KEYSTONE FIRST
PA
01
—
336613
AETNA
PA
Enumeration date
06/10/2006
Last updated
08/19/2015
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