Healthcare Provider Details

I. General information

NPI: 1740203215
Provider Name (Legal Business Name): CATHERINE SUZANNE RUDE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ONE SOUTH PROSPECT STREET UNIVERSITY PEDIATRICS
BURLINGTON VT
05401
US

IV. Provider business mailing address

380 SOUTH ST
SOUTH HERO VT
05486-4819
US

V. Phone/Fax

Practice location:
  • Phone: 802-847-4544
  • Fax: 802-847-4612
Mailing address:
  • Phone: 802-372-3365
  • Fax: 802-847-4612

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0420008347
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: