Provider Demographics
NPI:1396222816
Name:MAHLER, RUDINA A
Entity type:Individual
Prefix:
First Name:RUDINA
Middle Name:A
Last Name:MAHLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1005 MERIDIAN WAY
Mailing Address - Street 2:
Mailing Address - City:YARDLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19067-5835
Mailing Address - Country:US
Mailing Address - Phone:215-870-6795
Mailing Address - Fax:855-275-8434
Practice Address - Street 1:1005 MERIDIAN WAY
Practice Address - Street 2:
Practice Address - City:YARDLEY
Practice Address - State:PA
Practice Address - Zip Code:19067-5835
Practice Address - Country:US
Practice Address - Phone:215-870-6795
Practice Address - Fax:855-275-8434
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-26
Last Update Date:2018-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA253Z00000XMedicaid