Provider Demographics
NPI:1538162243
Name:JUDGE SWANEY, CATHY M (MD)
Entity type:Individual
Prefix:
First Name:CATHY
Middle Name:M
Last Name:JUDGE SWANEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:CATHY
Other - Middle Name:M
Other - Last Name:JUDGE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1617 NC HWY 66 SOUTH
Mailing Address - Street 2:STE 101
Mailing Address - City:KERNERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27284-3829
Mailing Address - Country:US
Mailing Address - Phone:336-993-2224
Mailing Address - Fax:336-993-0382
Practice Address - Street 1:1617 NC HWY 66 SOUTH
Practice Address - Street 2:STE 101
Practice Address - City:KERNERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27284-3829
Practice Address - Country:US
Practice Address - Phone:336-993-2224
Practice Address - Fax:336-993-0382
Is Sole Proprietor?:No
Enumeration Date:2005-05-27
Last Update Date:2010-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9500628207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8947641Medicaid
G29232Medicare UPIN
2226813Medicare ID - Type Unspecified