Healthcare Provider Details

I. General information

NPI: 1093962581
Provider Name (Legal Business Name): UDO RUDLOFF MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2008
Last Update Date: 12/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CENTER FOR CANCER RESEARCH CCR NCI NIH HATFIELD CENTER, ROOM 4-5940, 10 CENTER DRIVE
BETHESDA MD
20892-0001
US

IV. Provider business mailing address

4805 BROAD BROOK DR
BETHESDA MD
20814-3905
US

V. Phone/Fax

Practice location:
  • Phone: 301-496-3098
  • Fax: 301-402-1788
Mailing address:
  • Phone: 301-547-9226
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License NumberMD2007-0633
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License Number0101255226
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: