Healthcare Provider Details

I. General information

NPI: 1396066031
Provider Name (Legal Business Name): KATHERINE RUDICH BALDWIN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATHERINE RUDICH

II. Dates (important events)

Enumeration Date: 06/17/2010
Last Update Date: 07/21/2022
Certification Date: 04/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

282 WASHINGTON ST
HARTFORD CT
06106-3322
US

IV. Provider business mailing address

282 WASHINGTON ST
HARTFORD CT
06106-3322
US

V. Phone/Fax

Practice location:
  • Phone: 860-545-9560
  • Fax:
Mailing address:
  • Phone: 860-545-9560
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License Number56572
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: