MEDICARE: KATELYN EMILY RUDISILL MD, MPH

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	207R00000X	Internal Medicine Physician	MT236569	PA

General Provider Information

NPI Number	:	1497686810
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATELYN EMILY RUDISILL MD, MPH

Provider Business Mailing Address
First Line	:	5501 OLD YORK RD STE 1
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19141-3098
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	559 W GERMANTOWN PIKE
Second Line	:
City	:	NORRISTOWN
State	:	PA
Zip	:	19403-4250
Country	:	US
Telephone Number	:	484-622-1199
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/26/2026
Last Update Date	:	05/26/2026

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