Healthcare Provider Details

I. General information

NPI: 1609095389
Provider Name (Legal Business Name): RUDOLPH VALENTINO MCCOMB D.P.M
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: RUDOLPH VALENTINO MCCOMB D.P.M

II. Dates (important events)

Enumeration Date: 04/24/2007
Last Update Date: 10/25/2022
Certification Date: 10/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1933 E DUBLIN GRANVILLE RD STE 216
COLUMBUS OH
43229-3508
US

IV. Provider business mailing address

1933 E DUBLIN GRANVILLE RD STE 216
COLUMBUS OH
43229-3508
US

V. Phone/Fax

Practice location:
  • Phone: 614-339-4512
  • Fax: 614-339-4512
Mailing address:
  • Phone: 412-654-5464
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License NumberSCOO2810L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: