MEDICARE: DR. ROBIN A. RUDD PH.D.

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	103T00000X	Psychologist	MD2216	MD

General Provider Information

NPI Number	:	1932323573
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBIN A. RUDD PH.D.

Provider Business Mailing Address
First Line	:	4915 SAINT ELMO AVE
Second Line	:	SUITE 404
City	:	BETHESDA
State	:	MD
Zip	:	20814-6019
Country	:	US
Telephone Number	:	301-652-3290
Fax Number	:

Provider Business Practice Location Address
First Line	:	4915 SAINT ELMO AVE
Second Line	:	SUITE 404
City	:	BETHESDA
State	:	MD
Zip	:	20814-6019
Country	:	US
Telephone Number	:	301-652-3290
Fax Number	:

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

Provider Enumeration Date	:	04/13/2007
Last Update Date	:	07/08/2007

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