Individual
TERRA D RUDD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
100 BROWN ST, CHESTERTOWN, MD 21620-1435
(410) 778-7668
(410) 810-7186
Mailing address
100 BROWN ST, CHESTERTOWN, MD 21620-1435
(410) 778-7668
(410) 810-7186
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
0649
SD
363AM0700X
Medical Physician Assistant
0010-01645
NC
363AM0700X
Medical Physician Assistant
Primary
C0005108
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0010-01645
STATE MEDICAL LICENSE
NC
01
—
0649
LICENSE
SD
01
—
C0005108
PHYSICIAN ASSISTANT STATE LICENSE
MD
Enumeration date
05/12/2007
Last updated
08/21/2013
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