Provider Demographics
NPI:1417911082
Name:RUDMAN, EYDIE SUE (DO)
Entity Type:Individual
Prefix:
First Name:EYDIE
Middle Name:SUE
Last Name:RUDMAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1939 W CHELTENHAM AVE
Mailing Address - Street 2:
Mailing Address - City:ELKINS PARK
Mailing Address - State:PA
Mailing Address - Zip Code:19027-1046
Mailing Address - Country:US
Mailing Address - Phone:215-884-5715
Mailing Address - Fax:215-884-1442
Practice Address - Street 1:1939 W CHELTENHAM AVE
Practice Address - Street 2:
Practice Address - City:ELKINS PARK
Practice Address - State:PA
Practice Address - Zip Code:19027-1046
Practice Address - Country:US
Practice Address - Phone:215-884-5715
Practice Address - Fax:215-884-1442
Is Sole Proprietor?:No
Enumeration Date:2006-04-12
Last Update Date:2020-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS007808L208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAG09485Medicare UPIN