Basic Information
| Provider Information | |||||||||
| NPI: | 1497718035 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RUDMAN | ||||||||
| FirstName: | KATHRYN | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 25 COMMUNICATIONS WAY | ||||||||
| Address2: | MACC - REVENUE CYCLE | ||||||||
| City: | HYANNIS | ||||||||
| State: | MA | ||||||||
| PostalCode: | 026011866 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5089578664 | ||||||||
| FaxNumber: | 8059578677 | ||||||||
| Practice Location | |||||||||
| Address1: | 150 ANSEL HALLET RD | ||||||||
| Address2: | |||||||||
| City: | WEST YARMOUTH | ||||||||
| State: | MA | ||||||||
| PostalCode: | 02673 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5087718350 | ||||||||
| FaxNumber: | 5087718060 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/06/2006 | ||||||||
| LastUpdateDate: | 04/22/2010 | ||||||||
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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 | 208000000X | 158388 | MA | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | J21057 | 01 | MA | BCBS | OTHER | 3196631 | 05 | MA | MEDICAID | 202098 | 01 | MA | HPHC | OTHER |