Provider Demographics
NPI:1386658219
Name:WUDARSKY, MARIANNE (MD)
Entity type:Individual
Prefix:MS
First Name:MARIANNE
Middle Name:
Last Name:WUDARSKY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 E WOODS TRL
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:CT
Mailing Address - Zip Code:06422-3052
Mailing Address - Country:US
Mailing Address - Phone:203-415-5882
Mailing Address - Fax:
Practice Address - Street 1:33 E WOODS TRL
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:CT
Practice Address - Zip Code:06422-3052
Practice Address - Country:US
Practice Address - Phone:203-415-5882
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2024-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY218787-012084P0804X
CT310132084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDF36299Medicare UPIN