1609095389 NPI number — DR. RUDOLPH VALENTINO MCCOMB D.P.M

Table of content: DR. RUDOLPH VALENTINO MCCOMB D.P.M (NPI 1609095389)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609095389 NPI number — DR. RUDOLPH VALENTINO MCCOMB D.P.M

Organization/Personal Information

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

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MCCOMB
Provider Other First Name:
RUDOLPH
Provider Other Middle Name:
VALENTINO
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
D.P.M
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1609095389
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/25/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1933 E DUBLIN GRANVILLE RD
Provider Second Line Business Mailing Address:
STE 216
Provider Business Mailing Address City Name:
COLUMBUS
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43229-3508
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
412-654-5464
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1933 E DUBLIN GRANVILLE RD
Provider Second Line Business Practice Location Address:
STE 216
Provider Business Practice Location Address City Name:
COLUMBUS
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43229-3508
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
614-339-4512
Provider Business Practice Location Address Fax Number:
614-339-4512
Provider Enumeration Date:
04/24/2007

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: 213ES0131X , with the licence number:  SCOO2810L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 983906 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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