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General NPI Number Information
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NPI Number | 1053509513
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Entity Type | Organization
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Legal Business Name | TRI-COUNTY UROLOGY INC
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Dates
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Enumeration Date | 10/10/2007
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Last Update Date | 07/29/2008
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Provider Practice Location Address
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Address Line | 761 JOHNSONBURG RD SUITE 350
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City | SAINT MARYS
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State | PA
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Zip | 15857-3483
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Country | US
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Telephone | 814-781-8669
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Fax | 814-781-8671
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Provider Business Mailing Address
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Address Line | 761 JOHNSONBURG RD SUITE 350
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City | SAINT MARYS
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State | PA
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Zip | 15857-3483
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Country | US
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Telephone | 814-781-8669
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Fax | 814-781-8671
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DONALD H RUDICK
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Credential | MD
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Telephone | 814-781-8669
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number | MD056864L
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License Number State | PA
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