Basic Information
| Provider Information | |||||||||
| NPI: | 1083725089 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RUEDRICH | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3600 OLENTANGY RIVER RD | ||||||||
| Address2: | SUITE 490 | ||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432143437 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6144591000 | ||||||||
| FaxNumber: | 6144591382 | ||||||||
| Practice Location | |||||||||
| Address1: | 5150 BRADENTON AVE STE A | ||||||||
| Address2: | |||||||||
| City: | DUBLIN | ||||||||
| State: | OH | ||||||||
| PostalCode: | 430177589 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6147938544 | ||||||||
| FaxNumber: | 6157938563 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/31/2006 | ||||||||
| LastUpdateDate: | 10/28/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207VM0101X | 35051401 | OH | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Maternal & Fetal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 311621914 | 01 | OH | TAX ID | OTHER | 0117000 | 05 | OH | MEDICAID | 4034302 | 01 | OH | MEDICARE PTAN | OTHER |