Basic Information
| Provider Information | |||||||||
| NPI: | 1437131356 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RUDIN | ||||||||
| FirstName: | BENJAMIN | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 444 STOCKBRIDGE RD | ||||||||
| Address2: | SUITE 1 | ||||||||
| City: | GREAT BARRINGTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 012301295 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4137431080 | ||||||||
| FaxNumber: | 4137435306 | ||||||||
| Practice Location | |||||||||
| Address1: | 19 DEPOT ST | ||||||||
| Address2: | SUITE 1 | ||||||||
| City: | ADAMS | ||||||||
| State: | MA | ||||||||
| PostalCode: | 012201856 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4137431080 | ||||||||
| FaxNumber: | 4137435306 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/16/2005 | ||||||||
| LastUpdateDate: | 02/24/2016 | ||||||||
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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 | 207R00000X | 224382 | MA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 2113325 | 05 | MA | MEDICAID |