Individual
JONATHAN BRETT RUDICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
7331 HANOVER PKWY, STE B, GREENBELT, MD 20770-3621
(301) 345-0605
(301) 345-0606
Mailing address
7331 HANOVER PKWY, STE B, GREENBELT, MD 20770
(301) 345-0605
(301) 345-0606
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
D0053785
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00A612C73
MEDICARE
MD
01
—
61090905
BSMD
—
05
—
970900200
—
MD
01
—
F4550002
BSDC
—
01
—
LX76CE
BSMD
—
Enumeration date
04/18/2006
Last updated
09/27/2024
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