Provider Demographics
NPI:1285817429
Name:RUDICH, LYNN KAREN (MD)
Entity Type:Individual
Prefix:DR
First Name:LYNN
Middle Name:KAREN
Last Name:RUDICH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 N PEASE RD
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:CT
Mailing Address - Zip Code:06525-1621
Mailing Address - Country:US
Mailing Address - Phone:203-506-8909
Mailing Address - Fax:
Practice Address - Street 1:9 N PEASE RD
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:CT
Practice Address - Zip Code:06525-1621
Practice Address - Country:US
Practice Address - Phone:203-506-8909
Practice Address - Fax:203-397-2316
Is Sole Proprietor?:No
Enumeration Date:2007-12-11
Last Update Date:2020-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT028255208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004235900Medicaid