Provider Demographics
NPI:1508861568
Name:RUDMAN, MICHAEL STEPHEN (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:STEPHEN
Last Name:RUDMAN
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:PO BOX 20
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21769-0020
Mailing Address - Country:US
Mailing Address - Phone:301-371-9000
Mailing Address - Fax:301-371-8905
Practice Address - Street 1:300 S CHURCH ST
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:MD
Practice Address - Zip Code:21769-8043
Practice Address - Country:US
Practice Address - Phone:301-371-9000
Practice Address - Fax:301-371-8905
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD17106174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD814436OtherMDIPA #
MD4141250OtherAETNA #
MDH9310001OtherBCBS NCA #
MD42017501OtherBCBS MD #
MD0100076OtherUNITED HEALTHCARE #
MDH9310001OtherBCBS NCA #
MD0100076OtherUNITED HEALTHCARE #