Individual
DR. DAVID JUDY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
4610 KANAWHA AVE SW, SUITE 302, CHARLESTON, WV 25309-1320
(304) 925-7546
(681) 205-8369
Mailing address
# L-3555, COLUMBUS, OH 43260-0001
(304) 925-7546
(681) 205-8369
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
2007-00740
NC
207N00000X
Dermatology Physician
2596
WV
207N00000X
Dermatology Physician
OS 11120
FL
207ND0101X
MOHS-Micrographic Surgery Physician
Primary
2596
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1619144433
HEALTHNET/TRICARE
WV
01
—
2707397
HIGHMARK BCBS
WV
05
—
3810023193
—
WV
01
—
5679351
CIGNA
WV
Enumeration date
05/12/2008
Last updated
10/20/2014
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