Healthcare Provider Details

I. General information

NPI: 1518996107
Provider Name (Legal Business Name): JEFFREY A RUDOLPH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 05/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 CHILDRENS HOSPITAL DR 4401 PENN AVENUE
PITTSBURGH PA
15224-1529
US

IV. Provider business mailing address

1 CHILDRENS HOSPITAL DR 4401 PENN AVENUE
PITTSBURGH PA
15224-1529
US

V. Phone/Fax

Practice location:
  • Phone: 412-692-5180
  • Fax: 412-692-7355
Mailing address:
  • Phone: 412-692-5180
  • Fax: 412-692-7355

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License Number432827
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: