Fudge, Marilyn W

Fudge, Marilyn W is an individual health care provider with primary practice located at 700 6Th St S , St Petersburg FL 33701-4815. She recently has only one registered license in Allopathic & Osteopathic Physicians / Obstetrics & Gynecology, which is considered as her primary health care specialty. Fudge, Marilyn W can be contacted via phone (727) 893-6198.

Contact Information

Primary practice address
700 6Th St S St Petersburg FL 33701-4815
Phone: (727) 893-6198
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Obstetrics & Gynecology 207V00000X ME79050 Florida

Profile Details

NPI number 1306822887
LBN Legal business name Fudge, Marilyn W
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Dec 16th, 2005
Last updated May 21st, 2015 - about 10 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1306822887 NPPES
Florida MEDICAID 264650100

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