Healthcare Provider Details

I. General information

NPI: 1982896999
Provider Name (Legal Business Name): RUDOLPH J MOREIRA MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2007
Last Update Date: 08/14/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9403 KENWOOD RD SUITE B200
CINCINNATI OH
45242-6895
US

IV. Provider business mailing address

9403 KENWOOD RD SUITE B200
CINCINNATI OH
45242-6895
US

V. Phone/Fax

Practice location:
  • Phone: 513-281-1252
  • Fax: 513-281-1161
Mailing address:
  • Phone: 513-281-1252
  • Fax: 513-281-1161

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number35035368
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number35035368
License Number StateOH

VIII. Authorized Official

Name: DR. RUDOLPH J MOREIRA
Title or Position: PRESIDENT OF CORPORATION
Credential: M.D.
Phone: 513-281-1252