Healthcare Provider Details

I. General information

NPI: 1679676704
Provider Name (Legal Business Name): RUDMAN & KANE PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

807 E MAIN ST
MIDDLETOWN MD
21769
US

IV. Provider business mailing address

807 E MAIN ST
MIDDLETOWN MD
21769
US

V. Phone/Fax

Practice location:
  • Phone: 301-293-6828
  • Fax: 301-371-4989
Mailing address:
  • Phone: 301-293-6828
  • Fax: 301-371-4989

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number7349
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number7537
License Number StateMD

VIII. Authorized Official

Name: DR. PAUL N KANE
Title or Position: OWNER
Credential: DDS
Phone: 301-293-6828