Basic Information
| Provider Information | |||||||||
| NPI: | 1386658219 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WUDARSKY | ||||||||
| FirstName: | MARIANNE | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 64742-05 | ||||||||
| Address2: | |||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212644742 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6144422400 | ||||||||
| FaxNumber: | 6144422403 | ||||||||
| Practice Location | |||||||||
| Address1: | 9901 MEDICAL CENTER DR | ||||||||
| Address2: | |||||||||
| City: | ROCKVILLE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 208503357 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6144422400 | ||||||||
| FaxNumber: | 6144422403 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/28/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0804X | D0054477 | MD | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Child & Adolescent Psychiatry |
No ID Information.