Provider Demographics
NPI:1689959835
Name:RUDOWSKY, TIMOTHY (LAC)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:
Last Name:RUDOWSKY
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1701 CORNWALL RD STE 101
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:PA
Mailing Address - Zip Code:17042-7480
Mailing Address - Country:US
Mailing Address - Phone:717-675-1788
Mailing Address - Fax:717-675-1800
Practice Address - Street 1:1701 CORNWALL RD STE 101
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:PA
Practice Address - Zip Code:17042-7480
Practice Address - Country:US
Practice Address - Phone:717-675-1788
Practice Address - Fax:717-675-1800
Is Sole Proprietor?:No
Enumeration Date:2011-10-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC156031171100000X
PAMA059068363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No171100000XOther Service ProvidersAcupuncturist