Provider Demographics
NPI:1720026537
Name:RUDIN, ROBERT LAWRENCE (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:LAWRENCE
Last Name:RUDIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:524 WILLIAMSTOWN RD STE A
Mailing Address - Street 2:
Mailing Address - City:SICKLERVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08081-1800
Mailing Address - Country:US
Mailing Address - Phone:856-728-1181
Mailing Address - Fax:856-728-1182
Practice Address - Street 1:1553 CHESTER PIKE STE 101
Practice Address - Street 2:
Practice Address - City:CRUM LYNNE
Practice Address - State:PA
Practice Address - Zip Code:19022-1022
Practice Address - Country:US
Practice Address - Phone:610-690-4485
Practice Address - Fax:610-876-9741
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2023-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA09512100207R00000X
PAMD042968E207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAG38853Medicare UPIN