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NPI Code Detail

MEDICARE: HEATHER RUDDOCK MD

MEDICARE: HEATHER RUDDOCK MD
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
1208000000XPediatrics PhysicianMD056728PA
2208000000XPediatrics Physician25MA08898000NJ

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1780631846
Entity Type Code : Individual
Provider Name (Legal Business Name) : HEATHER RUDDOCK MD
Provider Business Mailing Address
First Line : 401 ROUTE 73 N
Second Line : BLDG 10, SUITE 320
City : MARLTON
State : NJ
Zip : 08053
Country : US
Telephone Number : 215-774-1166
Fax Number : 215-279-8383
Provider Business Practice Location Address
First Line : 2000 HAMILTON ST STE 301
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19130-3874
Country : US
Telephone Number : 215-774-1166
Fax Number : 215-279-8383
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/27/2006
Last Update Date : 03/27/2023

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Directions to “ HEATHER RUDDOCK MD” Practice Location

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