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General NPI Number Information
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NPI Number | 1851596282
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Entity Type | Organization
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Legal Business Name | ROBERT I. RUDOLPH, M.D. LTD
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Dates
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Enumeration Date | 06/16/2007
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Last Update Date | 03/14/2008
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Provider Practice Location Address
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Address Line | 1134 PENN AVE
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City | WYOMISSING
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State | PA
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Zip | 19610-2034
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Country | US
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Telephone | 610-374-4463
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Fax |
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Provider Business Mailing Address
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Address Line | 1134 PENN AVE
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City | WYOMISSING
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State | PA
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Zip | 19610-2034
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Country | US
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Telephone | 610-374-4463
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ROBERT I. RUDOLPH
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Credential | M.D.
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Telephone | 610-374-4463
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | MD-013472E
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License Number State | PA
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