MEDICARE: RUDDELL MEDICAL SERVICES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261Q00000X	Clinic/Center
2	261QP2300X	Primary Care Clinic/Center

General Provider Information

NPI Number	:	1184448623
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RUDDELL MEDICAL SERVICES

Provider Business Mailing Address
First Line	:	1361 OTIS PL NW
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20010-3436
Country	:	US
Telephone Number	:	301-296-0720
Fax Number	:	301-296-0732

Provider Business Practice Location Address
First Line	:	7676 NEW HAMPSHIRE AVE STE 424
Second Line	:
City	:	TAKOMA PARK
State	:	MD
Zip	:	20912-7516
Country	:	US
Telephone Number	:	301-296-0720
Fax Number	:

Authorized Official
Title or Position	:	NURSE PRACTITIONER / PRESIDENT
Name	:	DR. VASHTINA ELLISON-RUDDOCK
Credential	:	DNP,CRNP, FNP-BC
Telephone Number	:	202-549-0925

Provider Enumeration Date	:	11/12/2024
Last Update Date	:	12/03/2024

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Directions to “RUDDELL MEDICAL SERVICES ” Practice Location

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