Healthcare Provider Details

I. General information

NPI: 1801913934
Provider Name (Legal Business Name): TODD JONATHAN RUDO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2007
Last Update Date: 01/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PAOLI MEMORIAL MEDICAL BLDG #2 255 W LANCASTER AVE SUITE 328
PAOLI PA
19301
US

IV. Provider business mailing address

207 N BROAD ST 3RD FLOOR
PHILADELPHIA PA
19107-1500
US

V. Phone/Fax

Practice location:
  • Phone: 610-647-2400
  • Fax: 610-647-3902
Mailing address:
  • Phone: 267-479-4165
  • Fax: 215-463-3820

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberMD421975
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License NumberMD421975
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: