Provider Demographics
NPI:1356505341
Name:RUDOLPH, JOSEPH N (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:N
Last Name:RUDOLPH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2550 SOM CENTER RD
Mailing Address - Street 2:WH-10
Mailing Address - City:WILLOUGHBY HILLS
Mailing Address - State:OH
Mailing Address - Zip Code:44094-9655
Mailing Address - Country:US
Mailing Address - Phone:440-943-2500
Mailing Address - Fax:440-516-8316
Practice Address - Street 1:2550 SOM CENTER RD
Practice Address - Street 2:WH-10
Practice Address - City:WILLOUGHBY HILLS
Practice Address - State:OH
Practice Address - Zip Code:44094-9655
Practice Address - Country:US
Practice Address - Phone:440-943-2500
Practice Address - Fax:440-516-8316
Is Sole Proprietor?:No
Enumeration Date:2008-07-18
Last Update Date:2011-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2486092084N0400X
OH0659862084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3110770Medicaid
OH7417461Medicare PIN