Provider Demographics
NPI:1740203215
Name:RUDE, CATHERINE SUZANNE (MD)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:SUZANNE
Last Name:RUDE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:380 SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH HERO
Mailing Address - State:VT
Mailing Address - Zip Code:05486-4819
Mailing Address - Country:US
Mailing Address - Phone:802-372-3365
Mailing Address - Fax:802-847-4612
Practice Address - Street 1:ONE SOUTH PROSPECT STREET
Practice Address - Street 2:UNIVERSITY PEDIATRICS
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401
Practice Address - Country:US
Practice Address - Phone:802-847-4544
Practice Address - Fax:802-847-4612
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0420008347208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT0420008347OtherLICENSE
VTOVN2469Medicaid