Provider Demographics
NPI:1942272612
Name:RUDOLF, SYLVIE C (MD)
Entity Type:Individual
Prefix:
First Name:SYLVIE
Middle Name:C
Last Name:RUDOLF
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 ALICE PECK DAY DR
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:NH
Mailing Address - Zip Code:03766-2694
Mailing Address - Country:US
Mailing Address - Phone:603-448-3121
Mailing Address - Fax:603-448-7462
Practice Address - Street 1:10 ALICE PECK DAY DR
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:NH
Practice Address - Zip Code:03766-2694
Practice Address - Country:US
Practice Address - Phone:603-448-3121
Practice Address - Fax:603-448-7462
Is Sole Proprietor?:No
Enumeration Date:2006-02-06
Last Update Date:2013-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0420008053207Q00000X
NH7554207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VTOVN2226Medicaid
NHRE063501Medicare PIN
VTVN2226Medicare ID - Type Unspecified
VTOVN2226Medicaid