Provider Demographics
NPI:1932140936
Name:RUNDORFF, ROBERT LINK (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:LINK
Last Name:RUNDORFF
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 1:16 ROSE ST
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15905-4327
Mailing Address - Country:US
Mailing Address - Phone:814-539-0257
Mailing Address - Fax:814-536-0963
Practice Address - Street 1:16 ROSE ST
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15905-4327
Practice Address - Country:US
Practice Address - Phone:814-539-0257
Practice Address - Fax:814-536-0963
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2020-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA038167E174400000X, 208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA78619OtherUNISON MEDPLUS ID NO
PA1360107OtherUMWA PROVIDER ID NO
PA0010835360004Medicaid
PA1025247OtherGATEWAY PROVIDER ID NUMBE
PA250001342OtherTRAVELERS MEDICARE
PAP025109OtherCHAMPUS ID NO.
PA1025247OtherGATEWAY PROVIDER ID NUMBE
PA250001342OtherTRAVELERS MEDICARE