Provider Demographics
NPI:1407841356
Name:RUDLOFF, MARY (PA-C)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:
Last Name:RUDLOFF
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:33 N MAIN ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:CASSADAGA
Mailing Address - State:NY
Mailing Address - Zip Code:14718-9600
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:12 CENTER ST
Practice Address - Street 2:SUITE 1
Practice Address - City:FREDONIA
Practice Address - State:NY
Practice Address - Zip Code:14063-1769
Practice Address - Country:US
Practice Address - Phone:716-679-2233
Practice Address - Fax:716-679-9698
Is Sole Proprietor?:No
Enumeration Date:2005-09-16
Last Update Date:2024-01-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY005154363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant