Provider Demographics
NPI:1952388712
Name:RUDOLF, LEONARD M (MD)
Entity Type:Individual
Prefix:
First Name:LEONARD
Middle Name:M
Last Name:RUDOLF
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 1:10 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 1:17 ALICE PECK DAY DR UNIT C
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:NH
Practice Address - Zip Code:03766-2684
Practice Address - Country:US
Practice Address - Phone:603-448-6344
Practice Address - Fax:603-448-3405
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2017-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH7449207X00000X, 207XS0117X
VT0420007597207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30207509Medicaid
NHVN224302OtherMEDICARE B PTAN
NHNH0016OtherMEDICARE PTAN
VT0009184Medicaid
VT0009184Medicaid
NHVN224302OtherMEDICARE B PTAN
NHNH0016OtherMEDICARE PTAN