1376630731 NPI number — SARA JEAN RUDDY PA-C

Table of content: SARA JEAN RUDDY PA-C (NPI 1376630731)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376630731 NPI number — SARA JEAN RUDDY PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RUDDY
Provider First Name:
SARA
Provider Middle Name:
JEAN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PA-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1376630731
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/18/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
80 SEYMOUR STREET
Provider Second Line Business Mailing Address:
HARTFORD HOSPTIAL EMERGENCY MEDICINE
Provider Business Mailing Address City Name:
HARTFOD
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
06102-5037
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
860-972-0000
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
80 SEYMOUR STREET
Provider Second Line Business Practice Location Address:
HARTFORD HOSPITAL EMERGENCY MEDICINE
Provider Business Practice Location Address City Name:
HARTFORD
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06102-5037
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-972-0000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/06/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363A00000X , with the licence number:  MA052698 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363A00000X , with the licence number: 003327 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363AM0700X , with the licence number: 003327 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363AS0400X , with the licence number: 003327 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)