Provider Demographics
NPI:1912048695
Name:SAVAGE, RUDOLPH PATRICK JR (PHD)
Entity type:Individual
Prefix:DR
First Name:RUDOLPH
Middle Name:PATRICK
Last Name:SAVAGE
Suffix:JR
Gender:M
Credentials:PHD
Other - Prefix:DR
Other - First Name:R.
Other - Middle Name:PATRICK
Other - Last Name:SAVAGE
Other - Suffix:JR
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:1109 SPRING ST
Mailing Address - Street 2:SUITE 604
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910-4002
Mailing Address - Country:US
Mailing Address - Phone:301-587-2818
Mailing Address - Fax:301-774-0575
Practice Address - Street 1:1109 SPRING ST
Practice Address - Street 2:SUITE 604
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-4002
Practice Address - Country:US
Practice Address - Phone:301-587-2818
Practice Address - Fax:301-774-0575
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-08
Last Update Date:2011-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD2219103G00000X, 103TC0700X, 103TC1900X, 103TC2200X, 103TF0200X, 103TF0000X, 103TH0004X, 103TM1800X, 103TA0400X, 103TR0400X
MDMD 2219103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily
No103TH0004XBehavioral Health & Social Service ProvidersPsychologistHealth
No103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)
No103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD122773Medicare ID - Type Unspecified