Provider Demographics
NPI:1609029420
Name:RUDD, KENNETH WALKER II (MD, MPH, DABFM)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:WALKER
Last Name:RUDD
Suffix:II
Gender:M
Credentials:MD, MPH, DABFM
Other - Prefix:
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Mailing Address - Street 1:289 COUNTY RD
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:VT
Mailing Address - Zip Code:05089-9000
Mailing Address - Country:US
Mailing Address - Phone:802-674-6711
Mailing Address - Fax:802-674-7155
Practice Address - Street 1:289 COUNTY RD
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:VT
Practice Address - Zip Code:05089-9000
Practice Address - Country:US
Practice Address - Phone:802-674-6711
Practice Address - Fax:802-674-7155
Is Sole Proprietor?:No
Enumeration Date:2008-10-23
Last Update Date:2025-01-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NH15514207P00000X, 207Q00000X
CT042414207P00000X, 207Q00000X
VT042.0012952207P00000X
NJ25MA07905200207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH32001365Medicaid
VT1020400Medicaid
NH32001365Medicaid