Provider Demographics
NPI:1609095389
Name:MCCOMB, RUDOLPH VALENTINO (DPM)
Entity Type:Individual
Prefix:DR
First Name:RUDOLPH
Middle Name:VALENTINO
Last Name:MCCOMB
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:DR
Other - First Name:RUDOLPH
Other - Middle Name:VALENTINO
Other - Last Name:MCCOMB
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DPM
Mailing Address - Street 1:1933 E DUBLIN GRANVILLE RD
Mailing Address - Street 2:STE 216
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43229-3508
Mailing Address - Country:US
Mailing Address - Phone:412-654-5464
Mailing Address - Fax:
Practice Address - Street 1:1933 E DUBLIN GRANVILLE RD
Practice Address - Street 2:STE 216
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43229-3508
Practice Address - Country:US
Practice Address - Phone:614-339-4512
Practice Address - Fax:614-339-4512
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASCOO2810L213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA983906Medicaid
PA5194500001Medicare NSC