Provider Demographics
NPI:1841425030
Name:RUDNICK, MONA REZAI (MD)
Entity Type:Individual
Prefix:
First Name:MONA
Middle Name:REZAI
Last Name:RUDNICK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MONA
Other - Middle Name:L
Other - Last Name:REZAI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:10 DUKE MEDICINE CIR
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27710-1000
Mailing Address - Country:US
Mailing Address - Phone:888-275-3853
Mailing Address - Fax:919-681-8993
Practice Address - Street 1:10 DUKE MEDICINE CIR
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27710-1000
Practice Address - Country:US
Practice Address - Phone:888-275-3853
Practice Address - Fax:919-681-8993
Is Sole Proprietor?:No
Enumeration Date:2009-05-18
Last Update Date:2022-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CAA147572207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program