Provider Demographics
NPI:1801913934
Name:RUDO, TODD JONATHAN (MD)
Entity type:Individual
Prefix:DR
First Name:TODD
Middle Name:JONATHAN
Last Name:RUDO
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Gender:M
Credentials:MD
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Mailing Address - Street 1:207 N BROAD ST
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-1500
Mailing Address - Country:US
Mailing Address - Phone:267-479-4165
Mailing Address - Fax:215-463-3820
Practice Address - Street 1:PAOLI MEMORIAL MEDICAL BLDG #2
Practice Address - Street 2:255 W LANCASTER AVE SUITE 328
Practice Address - City:PAOLI
Practice Address - State:PA
Practice Address - Zip Code:19301
Practice Address - Country:US
Practice Address - Phone:610-647-2400
Practice Address - Fax:610-647-3902
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2013-01-14
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Provider Licenses
StateLicense IDTaxonomies
PAMD421975207RC0000X, 207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA101979357Medicaid
PAP01078707OtherRR MEDICARE
PA111688GT6Medicare PIN