1962570887 NPI number — DIANE RUDZINSKI

Table of content: DIANE RUDZINSKI (NPI 1962570887)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962570887 NPI number — DIANE RUDZINSKI

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RUDZINSKI
Provider First Name:
DIANE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
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:
1962570887
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/25/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
226 HILLSBORO DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SILVER SPRING
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20902-3126
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
202-744-7618
Provider Business Mailing Address Fax Number:
301-754-1305

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
226 HILLSBORO DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SILVER SPRING
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20902-3126
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
202-744-7618
Provider Business Practice Location Address Fax Number:
301-754-1305
Provider Enumeration Date:
11/30/2006

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: 1041C0700X , with the licence number:  10393 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 10393 . This is a "CLINICAL SOCIAL WORKER" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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