Provider Demographics
NPI:1538166798
Name:BARRY, REBECCA RUDD (MD)
Entity type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:RUDD
Last Name:BARRY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:REBECCA
Other - Middle Name:JEAN
Other - Last Name:RUDD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 79262
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21279-0262
Mailing Address - Country:US
Mailing Address - Phone:703-938-5700
Mailing Address - Fax:703-938-4467
Practice Address - Street 1:243 CHURCH ST NW
Practice Address - Street 2:SUITE 200 C
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22180-4434
Practice Address - Country:US
Practice Address - Phone:703-938-5700
Practice Address - Fax:703-938-4467
Is Sole Proprietor?:No
Enumeration Date:2005-07-02
Last Update Date:2008-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101225619207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
H31529Medicare UPIN
00A126L77Medicare PIN