Provider Demographics
NPI:1083725089
Name:RUEDRICH, DAVID A (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:A
Last Name:RUEDRICH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3600 OLENTANGY RIVER RD
Mailing Address - Street 2:SUITE 490
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43214-3437
Mailing Address - Country:US
Mailing Address - Phone:614-459-1000
Mailing Address - Fax:614-459-1382
Practice Address - Street 1:5150 BRADENTON AVE STE A
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43017-7589
Practice Address - Country:US
Practice Address - Phone:614-793-8544
Practice Address - Fax:615-793-8563
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2011-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35051401207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH311621914OtherTAX ID
OH0117000Medicaid
OH4034302OtherMEDICARE PTAN