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General NPI Number Information
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NPI Number | 1346351673
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Entity Type | Individual
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Provider Name | CHARLES RUDOLPH M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 04/22/2024
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Provider Practice Location Address
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Address Line | 170 MOUSE CREEK RD NW
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City | CLEVELAND
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State | TN
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Zip | 37312-3840
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Country | US
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Telephone | 423-458-1426
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Fax | 423-790-1276
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Provider Business Mailing Address
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Address Line | 1025 PEERLESS XING NW
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City | CLEVELAND
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State | TN
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Zip | 37312-3764
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Country | US
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Telephone | 423-476-5990
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Fax | 423-476-5887
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | MD32155
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License Number State | TN
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