Provider Demographics
NPI:1902259880
Name:RUDERMAN, MICHAEL (DO, MPH)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:RUDERMAN
Suffix:
Gender:M
Credentials:DO, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2940 SUMMIT ST STE 2D
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94609-3416
Mailing Address - Country:US
Mailing Address - Phone:858-245-5644
Mailing Address - Fax:510-571-3149
Practice Address - Street 1:2940 SUMMIT ST STE 2D
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-3416
Practice Address - Country:US
Practice Address - Phone:858-245-5644
Practice Address - Fax:510-571-3149
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-15
Last Update Date:2025-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1744R1102X
CA20A181012084P0800X
MA390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes1744R1102XOther Service ProvidersSpecialistResearch Study
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry