Provider Demographics
NPI:1568427417
Name:RUDOLPH, JAMES L (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:L
Last Name:RUDOLPH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1620 TREMONT ST
Mailing Address - Street 2:BRIGHAM AND WOMENS HOSPITAL DIVISION OF AGING
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02120
Mailing Address - Country:US
Mailing Address - Phone:617-525-7631
Mailing Address - Fax:
Practice Address - Street 1:1620 TREMONT ST
Practice Address - Street 2:BRIGHAM AND WOMENS HOSPITAL DIVISION OF AGING
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02120
Practice Address - Country:US
Practice Address - Phone:617-525-7631
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA210587207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAA34613Medicaid
H69524Medicare UPIN
MAA34613Medicaid