Provider Demographics
NPI:1568523629
Name:RUDOLPH, NORMAN ERIC (MD)
Entity Type:Individual
Prefix:DR
First Name:NORMAN
Middle Name:ERIC
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 1:333 VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:RI
Mailing Address - Zip Code:02842-7230
Mailing Address - Country:US
Mailing Address - Phone:401-849-3925
Mailing Address - Fax:401-849-3929
Practice Address - Street 1:333 VALLEY RD
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:RI
Practice Address - Zip Code:02842-7230
Practice Address - Country:US
Practice Address - Phone:401-849-3925
Practice Address - Fax:401-849-3929
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2007-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD04177207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI001953OtherBLUE CHIP
RI9002323Medicaid
RI23232OtherRIBC
0400135OtherUNITED HEALTH
0555996OtherAETNA
0124162OtherSECURE HORIZONS
0124162OtherSECURE HORIZONS