Provider Demographics
NPI:1922065283
Name:RUDOLPH, JOSEPH PHILIP (MD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:PHILIP
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 1:330 CURRY HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15236-4621
Mailing Address - Country:US
Mailing Address - Phone:412-653-4900
Mailing Address - Fax:412-653-9969
Practice Address - Street 1:330 CURRY HOLLOW RD
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15236-4621
Practice Address - Country:US
Practice Address - Phone:412-653-4900
Practice Address - Fax:412-653-9969
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-28
Last Update Date:2010-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD021460E207K00000X
PA004627A291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA164789OtherHIGHMARK
PARU164789Medicare ID - Type Unspecified
C32541Medicare UPIN