Provider Demographics
NPI:1891730842
Name:RUEDA VASQUEZ, EDUARDO (MD)
Entity type:Individual
Prefix:DR
First Name:EDUARDO
Middle Name:
Last Name:RUEDA VASQUEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 HIGHLAND DR
Mailing Address - Street 2:P.O. BOX 597
Mailing Address - City:MOUNTVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17554-1232
Mailing Address - Country:US
Mailing Address - Phone:717-285-7121
Mailing Address - Fax:717-285-2658
Practice Address - Street 1:1000 COMMERCE PARK DR
Practice Address - Street 2:SUITE 110
Practice Address - City:WILLIAMSPORT
Practice Address - State:PA
Practice Address - Zip Code:17701-5475
Practice Address - Country:US
Practice Address - Phone:570-323-6944
Practice Address - Fax:570-323-4529
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2013-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD4383592084P0800X
GA188682084P0800X
VA01010485972084P0800X
NY2237122084P0800X
FL313322084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1028002940001Medicaid
286279Medicare PIN