Provider Demographics
NPI:1558354902
Name:PUDIMAT, MARY ANN S (MD)
Entity Type:Individual
Prefix:DR
First Name:MARY ANN
Middle Name:S
Last Name:PUDIMAT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:ANN
Other - Last Name:SNEERINGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3998 FAIR RIDGE DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22033-2907
Mailing Address - Country:US
Mailing Address - Phone:703-295-9360
Mailing Address - Fax:703-766-9725
Practice Address - Street 1:61 EMERALD GLEN LANE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:CT
Practice Address - Zip Code:06420
Practice Address - Country:US
Practice Address - Phone:860-887-9073
Practice Address - Fax:860-887-9073
Is Sole Proprietor?:No
Enumeration Date:2005-08-31
Last Update Date:2015-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT037961207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001379610Medicaid
CT050001150Medicare PIN
CT001379610Medicaid