Individual
THERESA WENDEL RUDDY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
5100 W TAFT RD STE 4A, LIVERPOOL, NY 13088-3810
(315) 458-2211
(315) 452-9025
Mailing address
5100 W TAFT RD STE 4A, LIVERPOOL, NY 13088-3810
(315) 458-2211
(315) 452-9025
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
255925
NY
2086S0127X
Trauma Surgery Physician
255925
NY
208C00000X
Colon & Rectal Surgery Physician
Primary
18258-875
WI
208C00000X
Colon & Rectal Surgery Physician
255925
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03280522
—
NY
Enumeration date
05/29/2007
Last updated
06/11/2018
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