Rudolph, Ivan

Rudolph, Ivan is an individual health care provider with primary practice located at 132 S 10Th St 480 Main Building, Phila PA 19107-5244. He recently has only one registered license in Allopathic & Osteopathic Physicians / Gastroenterology, which is considered as his primary health care specialty. Rudolph, Ivan can be contacted via phone (215) 955-8900.

Contact Information

Primary practice address
132 S 10Th St 480 Main Building Phila PA 19107-5244
Phone: (215) 955-8900
Fax: (215) 955-5245
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Gastroenterology 207RG0100X MD006250E Pennsylvania

Profile Details

NPI number 1053371930
LBN Legal business name Rudolph, Ivan
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Mar 24th, 2006
Last updated Jul 8th, 2007 - about 18 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1053371930 NPPES
Pennsylvania MEDICAID 0017270520003

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