Mary L Fudge, MD

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

14621 Issued in NH

Practice address

789 Central Ave
Dover, NH 03820-2526

Phone

(603) 749-2266

NPI assigned

Oct 17, 2006

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Dr. Mary F Fannon Former name

Medicare fee-for-service enrollment

Enrolled in NH

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

General Surgery

Education

University of Pittsburgh School of Medicine, 2004

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Wentworth Douglass Physician CorporationGroup PAC ID 5496749848, 429 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Wentworth-Douglass Hospital Hospital, Dover, NH, CCN 300018

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: fudge.mary.wdh@direct.partners.masshiway.net
• FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/
• FHIR API: https://fhir.meditouchehr.com/api/fhir/r4/

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Wentworth Douglass Physician Corporation

  • Magnetic Resonance Imaging Radiologic Technologist
  • Dover, NH
  • NPI 1447352430
  Medicare reassignment Care Compare group NPD
• Core Physicians, LLC

  • Family Medicine Physician
  • Exeter, NH
  • NPI 1336330588

  Surgery

  Medicare reassignment NPD
• Core Physicians LLC

  • Durable Medical Equipment & Medical Supplies
  • Raymond, NH
  • NPI 1083085724
  NPD
• Wentworth Douglass Hospital

  • General Acute Care Hospital
  • Portsmouth, NH
  • NPI 1528687829
  NPD
• Wentworth Douglass Physician Corporation

  • Diagnostic Radiology Physician
  • Somersworth, NH
  • NPI 1295326494
  NPD
• Westchester Neurological Consultant PC

  • Neurology Physician
  • Yonkers, NY
  • NPI 1114950136
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Wentworth Douglass Hospital

  • General Acute Care Hospital
  • Dover, NH
  • NPI 1033118104
  Care Compare affiliation
• Wentworth Douglass Hospital

  • Diabetes Educator Registered Nurse
  • Dover, NH
  • NPI 1407385198

  Hospital

  Care Compare affiliation

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1161043200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1736208000000",
    "number": "1962583047",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 412503",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "022412503"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "789 CENTRAL AVE",
            "city": "DOVER",
            "state": "NH",
            "postal_code": "038202526",
            "telephone_number": "603-749-2266"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3 Alumni Dr Ste 301",
            "address_purpose": "LOCATION",
            "city": "Exeter",
            "state": "NH",
            "postal_code": "038332123",
            "country_code": "US",
            "telephone_number": "603-775-7405",
            "fax_number": "603-775-7424",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FUDGE",
        "first_name": "MARY",
        "middle_name": "L",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-10-17",
        "last_updated": "2025-01-07",
        "certification_date": "2025-01-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "NH",
            "license": "14621",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3074322",
            "state": "NH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MARY",
            "last_name": "FANNON",
            "middle_name": "F",
            "prefix": "DR.",
            "credential": "M.D.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Fresenius Medical Care Seacoast, LLC
• Ashton Frey, OTR/L
• Katherine B Frick, MSW
• Jacquelyn Kyra Frobese, D.C.
• John J Froelich, M.D.
• Ryan Fuller, OD
• Michelina Gabriel
• Sarah Marie Gaffney-Cobb, PA-C
• Samantha Gagne, PA-C
• Christopher Eric Gagnon, AGACNP-BC

• Surgery Physician in Dover, NH
• Providers in Dover, NH by specialty
• Surgery Physician in New Hampshire

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 7, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.