Basic Information
| Provider Information | |||||||||
| NPI: | 1649358615 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RUDY | ||||||||
| FirstName: | TODD | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 40 W WELLSBORO ST | ||||||||
| Address2: | |||||||||
| City: | MANSFIELD | ||||||||
| State: | PA | ||||||||
| PostalCode: | 169331411 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5706621945 | ||||||||
| FaxNumber: | 5706622390 | ||||||||
| Practice Location | |||||||||
| Address1: | 103 FORESTVIEW AVE | ||||||||
| Address2: | |||||||||
| City: | ELKLAND | ||||||||
| State: | PA | ||||||||
| PostalCode: | 169201403 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8142585117 | ||||||||
| FaxNumber: | 8142585510 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/01/2006 | ||||||||
| LastUpdateDate: | 07/08/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/08/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | MA002854L | PA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.