Provider Demographics
NPI:1144228230
Name:RUDOI, SERGIO JR (PA-C)
Entity Type:Individual
Prefix:
First Name:SERGIO
Middle Name:
Last Name:RUDOI
Suffix:JR
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1255 S CEDAR CREST BLVD
Mailing Address - Street 2:SUITE 3600
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18103-6256
Mailing Address - Country:US
Mailing Address - Phone:610-770-1606
Mailing Address - Fax:610-740-0560
Practice Address - Street 1:1255 S CEDAR CREST BLVD
Practice Address - Street 2:SUITE 3600
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18103-6256
Practice Address - Country:US
Practice Address - Phone:610-770-1606
Practice Address - Fax:610-740-0560
Is Sole Proprietor?:No
Enumeration Date:2005-07-12
Last Update Date:2018-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA050760363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
P3177389OtherOXFORD HEALTH PLANS
1958665OtherHIGHMARK BLUE SHIELD
50047059OtherCAPITAL BLUE CROSS
970022168OtherMEDICARE RAILROAD
329247OtherHEALTHAMERICA/HEALTHASSUR
50047059OtherKEYSTONE HEALTH CENTRAL
970022168OtherMEDICARE RAILROAD
1958665OtherHIGHMARK BLUE SHIELD