Active NPI
Matthew V Rudorfer, M.D.
- Psychiatry Physician
- Rockville, MD
National Provider Identifier
1477654465
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- D27335
- Practice address
- 6131 Executive Blvd
Rockville, MD 20852-3901 - Phone
- (301) 424-5773
- Fax
- (301) 424-5773
- NPI assigned
- Sep 25, 2006
- Last updated
- Jul 5, 2010
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | D27335 | MD | Primary |
Addresses
Primary practice location
6131 Executive Blvd
Rockville, MD 20852-3901
Mailing address
11809 Ambleside Dr
Potomac, MD 20854-2105
Phone (301) 424-5773
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
- Opted out of Medicare
- Yes, effective Aug 9, 2015 through Aug 9, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| D27335 | MD | MD | Psychiatry Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159142400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1278288000000",
"number": "1477654465",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11809 AMBLESIDE DR",
"city": "POTOMAC",
"state": "MD",
"postal_code": "208542105",
"telephone_number": "301-424-5773",
"fax_number": "301-424-5773"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6131 EXECUTIVE BLVD",
"city": "ROCKVILLE",
"state": "MD",
"postal_code": "208523901",
"telephone_number": "301-424-5773",
"fax_number": "301-424-5773"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RUDORFER",
"first_name": "MATTHEW",
"middle_name": "V",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-09-25",
"last_updated": "2010-07-05",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "MD",
"license": "D27335",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Rockville, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 5, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.