1295702124 NPI number — DR. WILLIAM GARRY RUDOLPH M.D.

Table of content: DR. WILLIAM GARRY RUDOLPH M.D. (NPI 1295702124)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295702124 NPI number — DR. WILLIAM GARRY RUDOLPH M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RUDOLPH
Provider First Name:
WILLIAM
Provider Middle Name:
GARRY
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1295702124
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/22/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2453 BLUE CASTLE LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VIRGINIA BEACH
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23454-1921
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
757-443-5760
Provider Business Mailing Address Fax Number:
757-443-5767

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1283 TOW WAY DRIVE
Provider Second Line Business Practice Location Address:
CODE N02M
Provider Business Practice Location Address City Name:
NORFOLK
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23511
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
757-443-5760
Provider Business Practice Location Address Fax Number:
757-443-5767
Provider Enumeration Date:
02/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2083X0100X , with the licence number:  0101040327 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com