Provider Demographics
NPI:1609029420
Name:RUDD, KENNETH WALKER II (MD, MPH, DABFM)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:WALKER
Last Name:RUDD
Suffix:II
Gender:M
Credentials:MD, MPH, DABFM
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Mailing Address - Street 1:37 DEWEY FIELD RD
Mailing Address - Street 2:2ND FLOOR- HB7256
Mailing Address - City:HANOVER
Mailing Address - State:NH
Mailing Address - Zip Code:03755-1419
Mailing Address - Country:US
Mailing Address - Phone:603-650-4000
Mailing Address - Fax:603-646-2268
Practice Address - Street 1:18 OLD ETNA RD
Practice Address - Street 2:DHMC DEPARTMENT OF FAMILY MEDICINE
Practice Address - City:LEBANON
Practice Address - State:NH
Practice Address - Zip Code:03766
Practice Address - Country:US
Practice Address - Phone:603-650-4000
Practice Address - Fax:603-650-4190
Is Sole Proprietor?:No
Enumeration Date:2008-10-23
Last Update Date:2014-09-23
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Provider Licenses
StateLicense IDTaxonomies
NH15514207P00000X, 207Q00000X
CT042414207P00000X, 207Q00000X
NJ25MA07905200207Q00000X
VT042.0012952207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1020400Medicaid
NH32001365Medicaid
NH32001365Medicaid