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General NPI Number Information
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NPI Number | 1366490534
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Entity Type | Individual
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Provider Name | MARK N RUDOLPH M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/04/2006
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Last Update Date | 02/07/2014
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Provider Practice Location Address
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Address Line | 23 ISAAC ST
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City | MIDDLEBORO
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State | MA
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Zip | 02346-2080
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Country | US
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Telephone | 774-419-1022
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Fax | 774-419-1034
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Provider Business Mailing Address
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Address Line | 23 ISAAC ST
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City | MIDDLEBORO
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State | MA
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Zip | 02346-2080
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Country | US
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Telephone | 774-419-1022
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Fax | 774-419-1034
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 210226
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License Number State | MA
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