Organization
LORI WILLIAMS-RUDALAVAGE MD LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LORI WILLIAMS MD (OWNER)
(570) 230-0036
Entity
Organization
Contact information
Practice address
157 SCRANTON CARBONDALE HWY, PINELINE PLAZA, EYNON, PA 18403-1027
(570) 230-0036
(570) 230-0042
Mailing address
157 SCRANTON CARBONDALE HWY, PINELINE PLAZA, EYNON, PA 18403-1027
(570) 230-0036
(570) 230-0042
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
MD057902L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2680260
PA BLUE SHIELD
PA
01
—
616435200
US DEPT OF LABOR- FECA/BLACK LUNG
PA
Enumeration date
12/01/2011
Last updated
01/19/2012
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