Provider Demographics
NPI:1396739496
Name:RUDY, FRANK R (MD)
Entity type:Individual
Prefix:
First Name:FRANK
Middle Name:R
Last Name:RUDY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:4520 UNION DEPOSIT RD
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17111-2910
Mailing Address - Country:US
Mailing Address - Phone:717-652-6105
Mailing Address - Fax:717-652-2165
Practice Address - Street 1:111 SOUTH FRONT STREET
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17104-8700
Practice Address - Country:US
Practice Address - Phone:717-782-5640
Practice Address - Fax:717-782-5352
Is Sole Proprietor?:No
Enumeration Date:2005-09-02
Last Update Date:2013-09-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD016641E207ZP0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0009496730001Medicaid
PA0009496730005Medicaid
PA220018591OtherRAILROAD MEDICARE
PA0009496730001Medicaid
PA154650G03Medicare PIN