Provider Demographics
NPI:1649778101
Name:RUDD, NATASHA (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:
First Name:NATASHA
Middle Name:
Last Name:RUDD
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 CLARICE AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28204-2768
Mailing Address - Country:US
Mailing Address - Phone:704-348-4000
Mailing Address - Fax:
Practice Address - Street 1:400 CLARICE AVE STE 100
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28204-2768
Practice Address - Country:US
Practice Address - Phone:704-348-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-30
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNC0010-07745207QB0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QB0002XAllopathic & Osteopathic PhysiciansFamily MedicineObesity Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GANC0010-07745OtherNORTH CAROLINA MEDICAL BOARD STATE LICENSE
GANC0010-07745OtherNORTH CAROLINA MEDICAL BOARD STATE LICENSE