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General NPI Number Information
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NPI Number | 1700097698
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Entity Type | Individual
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Provider Name | TIFFANY F RUDLOE MD
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Gender | Female
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Dates
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Enumeration Date | 05/24/2007
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Last Update Date | 07/01/2013
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Provider Practice Location Address
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Address Line | 32 RESORT WAY
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City | ELLSWORTH
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State | ME
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Zip | 04605-1717
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Country | US
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Telephone | 207-664-7744
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Fax | 207-664-7724
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Provider Business Mailing Address
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Address Line | 50 UNION ST MAINE COAST PEDIATRICS
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City | ELLSWORTH
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State | ME
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Zip | 04605-1534
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Country | US
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Telephone | 207-664-7744
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Fax | 207-664-7724
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 227781
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | MD19683
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License Number State | ME
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