Provider Demographics
NPI:1952839243
Name:RUDIN, SHELDON D
Entity Type:Individual
Prefix:
First Name:SHELDON
Middle Name:D
Last Name:RUDIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:170 W RIDGELY RD STE 310
Mailing Address - Street 2:
Mailing Address - City:TIMONIUM
Mailing Address - State:MD
Mailing Address - Zip Code:21093-5127
Mailing Address - Country:US
Mailing Address - Phone:410-308-4021
Mailing Address - Fax:
Practice Address - Street 1:170 W RIDGELY RD STE 310
Practice Address - Street 2:
Practice Address - City:TIMONIUM
Practice Address - State:MD
Practice Address - Zip Code:21093-5127
Practice Address - Country:US
Practice Address - Phone:410-308-4021
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-31
Last Update Date:2017-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD29235208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation