Healthcare Provider Details

I. General information

NPI: 1902843113
Provider Name (Legal Business Name): MARGARET RUDDY PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2006
Last Update Date: 12/01/2022
Certification Date: 12/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3235 MILL VISTA RD
HIGHLANDS RANCH CO
80129-2440
US

IV. Provider business mailing address

5730 EXECUTIVE DR STE 230
CATONSVILLE MD
21228-1762
US

V. Phone/Fax

Practice location:
  • Phone: 303-876-8320
  • Fax: 888-701-4175
Mailing address:
  • Phone: 303-876-8320
  • Fax: 888-701-4175

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number1682
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: