Healthcare Provider Details

I. General information

NPI: 1538628540
Provider Name (Legal Business Name): CHRISTINA MARGARET RUDOLPH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2019
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

47 NEW SCOTLAND AVENUE, DEPT OF PLASTIC SURGERY
ALBANY NY
12208
US

IV. Provider business mailing address

50 NEW SCOTLAND AVE FL 1
ALBANY NY
12208-3403
US

V. Phone/Fax

Practice location:
  • Phone: 518-262-2229
  • Fax: 518-262-6358
Mailing address:
  • Phone: 518-262-2229
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number344346
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: