Active NPI
Bonita Louise Jude, MD
- Pediatrics Physician
- Fort Meade, MD
National Provider Identifier
1336139880
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- D0051446
- Practice address
- 2480 Llewellyn Ave
Fort Meade, MD 20755-7081 - Phone
- (301) 677-8641
- Fax
- (301) 677-8485
- NPI assigned
- Oct 26, 2005
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | D0051446 | MD | Primary |
Addresses
Primary practice location
2480 Llewellyn Ave
Fort Meade, MD 20755-7081
Mailing address
2480 Llewellyn Ave
Fort Meade, MD 20755-7081
Phone (301) 460-0619
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| D0051446 | MD | MD | Pediatrics Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1130284800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1681862400000",
"number": "1336139880",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2480 LLEWELLYN AVE",
"city": "FORT MEADE",
"state": "MD",
"postal_code": "207557081",
"telephone_number": "301-460-0619",
"fax_number": "301-677-8485"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2480 LLEWELLYN AVE",
"city": "FORT MEADE",
"state": "MD",
"postal_code": "207557081",
"telephone_number": "301-677-8641",
"fax_number": "301-677-8485"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JUDE",
"first_name": "BONITA",
"middle_name": "LOUISE",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2005-10-26",
"last_updated": "2023-04-19",
"certification_date": "2023-04-19",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "MD",
"license": "D0051446",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Meade, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 19, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.