Provider Demographics
NPI:1235172495
Name:UDWADIA, RUSI A (MD)
Entity Type:Individual
Prefix:MR
First Name:RUSI
Middle Name:A
Last Name:UDWADIA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:4048 EVANS AVE #209
Mailing Address - Street 2:# 2
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33901-9385
Mailing Address - Country:US
Mailing Address - Phone:239-278-9983
Mailing Address - Fax:239-278-9985
Practice Address - Street 1:4048 EVANS AVE
Practice Address - Street 2:SUITE 209
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33901-9385
Practice Address - Country:US
Practice Address - Phone:239-278-9983
Practice Address - Fax:239-278-9985
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2015-08-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY103123-1208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00686966Medicaid
B71439Medicare UPIN
005050001OtherBLUE CROSS BLUE SHIELD
B71439Medicare UPIN