Healthcare Provider Details

I. General information

NPI: 1871564856
Provider Name (Legal Business Name): BRUCE J RUDIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2006
Last Update Date: 10/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4102 OGLETOWN STANTON RD STE B
NEWARK DE
19713-4183
US

IV. Provider business mailing address

211 EXECUTIVE DR STE 11
NEWARK DE
19702-3358
US

V. Phone/Fax

Practice location:
  • Phone: 302-894-1900
  • Fax: 302-894-0264
Mailing address:
  • Phone: 302-731-2888
  • Fax: 302-731-7049

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberC10003953
License Number StateDE
# 2
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License NumberCI0003953
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: