Provider Demographics
NPI:1326058900
Name:RUDY, BRET J (MD)
Entity type:Individual
Prefix:
First Name:BRET
Middle Name:J
Last Name:RUDY
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:100 N 20TH ST
Mailing Address - Street 2:CHCA SUITE 301
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19103-1443
Mailing Address - Country:US
Mailing Address - Phone:215-567-2422
Mailing Address - Fax:215-561-0959
Practice Address - Street 1:3550 MARKET ST FL4
Practice Address - Street 2:CHOP DEPARTMENT OF ADOLESCENT MEDICINE
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104
Practice Address - Country:US
Practice Address - Phone:215-590-3537
Practice Address - Fax:215-561-0959
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2025-09-11
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Provider Licenses
StateLicense IDTaxonomies
PAMD039136E208000000X, 2080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2217201Medicaid
NJ2217201Medicaid
F80186Medicare UPIN