Provider Demographics
NPI:1417173733
Name:RUDOLPH, DOROTHY A (MSW)
Entity Type:Individual
Prefix:
First Name:DOROTHY
Middle Name:A
Last Name:RUDOLPH
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:ALLIE
Other - Middle Name:
Other - Last Name:RUDOLPH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:200 DOUGLAS AVE APT 1G
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22902-5777
Mailing Address - Country:US
Mailing Address - Phone:434-293-6607
Mailing Address - Fax:434-972-4266
Practice Address - Street 1:LEE ST
Practice Address - Street 2:UVA DEPT OF FAMILY MEDICINE,
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22908-0001
Practice Address - Country:US
Practice Address - Phone:434-924-1622
Practice Address - Fax:434-982-4306
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040003021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAS07447Medicare UPIN