Provider Demographics
NPI:1083725840
Name:RUDOLPH, MARIANNE T (LD RD)
Entity Type:Individual
Prefix:MS
First Name:MARIANNE
Middle Name:T
Last Name:RUDOLPH
Suffix:
Gender:F
Credentials:LD RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6344 BRECKSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:OH
Mailing Address - Zip Code:44131-3405
Mailing Address - Country:US
Mailing Address - Phone:216-524-5319
Mailing Address - Fax:
Practice Address - Street 1:7007 POWERS BLVD
Practice Address - Street 2:PARMA COMMUNITY HOSP
Practice Address - City:PARMA
Practice Address - State:OH
Practice Address - Zip Code:44129-4595
Practice Address - Country:US
Practice Address - Phone:440-743-2150
Practice Address - Fax:440-743-2280
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH608133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered