Healthcare Provider Details

I. General information

NPI: 1578595013
Provider Name (Legal Business Name): MARIE G RUDDEN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

38 MAIN STREET 2ND FLOOR
WEST STOCKBRIDGE MA
01266
US

IV. Provider business mailing address

PO BOX 5
WEST STOCKBRIDGE MA
01266-0005
US

V. Phone/Fax

Practice location:
  • Phone: 413-232-0157
  • Fax:
Mailing address:
  • Phone: 413-232-0157
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number210298
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: