Provider Demographics
NPI:1497335442
Name:CHUKWUDIFU, BRIDGET NICOLE (MD)
Entity type:Individual
Prefix:
First Name:BRIDGET
Middle Name:NICOLE
Last Name:CHUKWUDIFU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:BRIDGET
Other - Middle Name:NICOLE
Other - Last Name:KEEHAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:804 BELVEDERE ST
Mailing Address - Street 2:
Mailing Address - City:CARLISLE
Mailing Address - State:PA
Mailing Address - Zip Code:17013-4000
Mailing Address - Country:US
Mailing Address - Phone:717-243-1943
Mailing Address - Fax:717-243-6708
Practice Address - Street 1:804 BELVEDERE ST
Practice Address - Street 2:
Practice Address - City:CARLISLE
Practice Address - State:PA
Practice Address - Zip Code:17013-4000
Practice Address - Country:US
Practice Address - Phone:717-243-1943
Practice Address - Fax:717-243-6708
Is Sole Proprietor?:No
Enumeration Date:2021-04-13
Last Update Date:2024-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
PAMT224382390200000X
PAMD484337208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program