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NPI Code Detail

MEDICARE: YVONNE NICOLE RUDDER M.D.

MEDICARE: YVONNE NICOLE RUDDER M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207R00000XInternal Medicine PhysicianD0060920MD

General Provider Information

NPI Number : 1699804344
Entity Type Code : Individual
Provider Name (Legal Business Name) : YVONNE NICOLE RUDDER M.D.
Provider Business Mailing Address
First Line : 1824 VARNUM ST NE
Second Line :
City : WASHINGTON
State : DC
Zip : 20018-3314
Country : US
Telephone Number : 301-758-7186
Fax Number :
Provider Business Practice Location Address
First Line : 4409 E WEST HWY
Second Line :
City : RIVERDALE
State : MD
Zip : 20737-1058
Country : US
Telephone Number : 703-359-7460
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/05/2007
Last Update Date : 03/19/2022

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