IVAN RUDOLPH (NPI# 1053371930) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1053371930 |
| Entity Type | Individual |
| Full Name | IVAN RUDOLPH |
| Credential | M.D. |
| Practice Address |
132 S 10th St 480 Main Building Phila PA 19107-5244 |
| Practice Telephone | 2159558900 |
| Practice Fax Number | 2159555245 |
| Mailing Telephone | 2159558900 |
| Mailing Fax Number | 2159555245 |
| Enumeration Date | 2006-03-24 |
| Last Update Date | 2007-07-08 |
| Gender Code | M |
| Is Sole Proprietor | X |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207RG0100X |
Internal Medicine Specialization: Gastroenterology |
MD006250E | PA | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| PA | 0017270520003 | 05 |
| Street Address |
132 S 10TH ST 480 MAIN BUILDING |
| City | PHILA |
| State | PA |
| Zip Code | 19107-5244 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1285926790 | Angela M Grabau | Nurse Practitioner | 132 S 10th St, 480 Main Building, Phila, PA 19107-5244 | 2011-05-03 |
| 1003866138 | Emily Rubin | Dietitian, Registered | 132 S 10th St, 480 Main Bldg., Phila, PA 19107-5244 | 2006-05-11 |
| 1962464479 | Dimarino-kroop-prieto Gastrointestinal Associates Pa | Internal Medicine | 132 S 10th St, 480 Main Building, Phila, PA 19107-5244 | 2006-04-03 |
| 1205898723 | Jefferson University Physicians | Internal Medicine | 132 S 10th St, 480 Main Building, Phila, PA 19107-5244 | 2006-04-03 |
| 1902868326 | University Gastroenterology and Hepatology Associates PC | Internal Medicine | 132 S 10th St, 480 Main Building, Phila, PA 19107-5244 | 2006-04-03 |
| 1952360596 | Thomas E. Kowalski | Internal Medicine | 132 S 10th St, 480 Main Building, Phila, PA 19107-5244 | 2006-03-22 |
| 1508825316 | David E. Loren | Internal Medicine | 132 S 10th St, 480 Main Building, Phila, PA 19107-5244 | 2006-03-21 |
| 1316906159 | Robin S. Miller | Nurse Practitioner | 132 S 10th St, 480 Main Building, Phila, PA 19107-5244 | 2006-03-21 |
| 1366401135 | Steven K. Herrine | Internal Medicine | 132 S 10th St, 480 Main Building, Phila, PA 19107-5244 | 2006-03-21 |
| 1821057720 | Sidney Cohen | Internal Medicine | 132 S 10th St, 480 Main Building, Phila, PA 19107-5244 | 2006-03-20 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578170940 | Stephanie Quist | Pharmacist | 1 S Broad Street, Philadelphia, PA 19107 | 2020-09-29 |
| 1457968448 | Cloudline Physical Therapy LLC | Physical Therapist | 239-241 South 10th St, Philadelphia, PA 19107 | 2020-09-24 |
| 1053931303 | Wilson Wong | Pharmacist | Cvs Pharmacy #450, 3401 Walnut St, Philadelphia, PA 19107 | 2020-04-16 |
| 1326608779 | Pascal Lavergne | Neurological Surgery | 111 11th St, Thomas Jefferson University, Philadelphia, PA 19107 | 2019-06-18 |
| 1639632185 | Taylor D'amore | Orthopaedic Surgery | 925 Chest Street 5th Floor, Philadelphia, PA 19107 | 2019-04-11 |
| 1043779630 | Heather Lynn Yenser | Nurse Practitioner | 111 S. 11th St., Jefferson Vascular Center (6th Floor), Philadelphia, PA 19107 | 2019-03-14 |
| 1174093702 | Jennifer Lynn Kengeter | Psychologist | 900 Walnut Street, Suite 200, Philadelphia, PA 19107 | 2018-11-27 |
| 1649751843 | Rachel Wint | Physician Assistant | 231 N Broad St Fl 2, Philadelphia, PA 19107 | 2018-08-24 |
| 1922588623 | Hyung Bin Lee | Dentist | 315 N 12th St, Apt 803, Philadelphia, PA 19107 | 2018-08-21 |
| 1750860490 | Anastasiya Khlypnych | Physician Assistant | 111 S. 11th Street, Suite 2170, Gibbon Bldg Suite 6210, Philadelphia, PA 19107 | 2018-08-13 |
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| Taxonomy Code | 207RG0100X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| Specialization | Gastroenterology |
| An internist who specializes in diagnosis and treatment of diseases of the digestive organs including the stomach, bowels, liver and gallbladder. This specialist treats conditions such as abdominal pain, ulcers, diarrhea, cancer and jaundice and performs complex diagnostic and therapeutic procedures using endoscopes to visualize internal organs. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/. American Osteopathic Board of Internal Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568499184 | Patricia Lorraine Kozuch | Internal Medicine | 132 S. 10th St., 480 Main Bldg, Phila, PA 19107 | 2006-06-27 |
| 1801926209 | Northeast Gastroenterology Associates Inc | Internal Medicine | 2000 Grant Ave, Suite 103, Phila, PA 19115-4378 | 2007-03-06 |
| 1902984255 | Marianne Theresa Ritchie | Internal Medicine | 132 S. 10th Street, 480 Main Bldg., Phila, PA 19107 | 2006-11-02 |
| 1871691212 | Broad & Joseph Associates | Internal Medicine | 1015 Chestnut St, Suite 916, Phila, PA 19107 | 2006-09-20 |
| 1073520458 | Alan M Mermelstein | Internal Medicine | 7439 Frankford Ave, Phila, PA 19136 | 2006-08-01 |
| 1235143983 | Linda Greenbaum | Internal Medicine | 132 S. 10th St., 480 Main Bldg., Phila, PA 19107 | 2006-07-28 |
| 1962464479 | Dimarino-kroop-prieto Gastrointestinal Associates Pa | Internal Medicine | 132 S 10th St, 480 Main Building, Phila, PA 19107-5244 | 2006-04-03 |
| 1205898723 | Jefferson University Physicians | Internal Medicine | 132 S 10th St, 480 Main Building, Phila, PA 19107-5244 | 2006-04-03 |
| 1902868326 | University Gastroenterology and Hepatology Associates PC | Internal Medicine | 132 S 10th St, 480 Main Building, Phila, PA 19107-5244 | 2006-04-03 |
| 1952360596 | Thomas E. Kowalski | Internal Medicine | 132 S 10th St, 480 Main Building, Phila, PA 19107-5244 | 2006-03-22 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.