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NPI Code Detail

MEDICARE: MARK N RUDOLPH M.D.

MEDICARE: MARK N RUDOLPH M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12084P0800XPsychiatry Physician210226MA

General Provider Information

NPI Number : 1366490534
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARK N RUDOLPH M.D.
Provider Business Mailing Address
First Line : 23 ISAAC ST
Second Line :
City : MIDDLEBORO
State : MA
Zip : 02346-2080
Country : US
Telephone Number : 774-419-1022
Fax Number : 774-419-1034
Provider Business Practice Location Address
First Line : 23 ISAAC ST
Second Line :
City : MIDDLEBORO
State : MA
Zip : 02346-2080
Country : US
Telephone Number : 774-419-1022
Fax Number : 774-419-1034
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/04/2006
Last Update Date : 02/07/2014

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