Provider Demographics
NPI:1982896999
Name:RUDOLPH J MOREIRA MD INC
Entity Type:Organization
Organization Name:RUDOLPH J MOREIRA MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OF CORPORATION
Authorized Official - Prefix:DR
Authorized Official - First Name:RUDOLPH
Authorized Official - Middle Name:J
Authorized Official - Last Name:MOREIRA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:513-281-1252
Mailing Address - Street 1:9403 KENWOOD RD
Mailing Address - Street 2:SUITE B200
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45242-6895
Mailing Address - Country:US
Mailing Address - Phone:513-281-1252
Mailing Address - Fax:513-281-1161
Practice Address - Street 1:9403 KENWOOD RD
Practice Address - Street 2:SUITE B200
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45242-6895
Practice Address - Country:US
Practice Address - Phone:513-281-1252
Practice Address - Fax:513-281-1161
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-14
Last Update Date:2007-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35035368208600000X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH5391302Medicaid
OH5391302Medicaid