Individual
DR. CHARLES RUDOLPH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
170 MOUSE CREEK RD NW, CLEVELAND, TN 37312-3840
(423) 458-1426
(423) 790-1276
Mailing address
1025 PEERLESS XING NW, CLEVELAND, TN 37312-3764
(423) 476-5990
(423) 476-5887
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
MD32155
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000931499D
—
GA
05
—
00931499A
—
GA
01
—
3148810
BCBS OF TENNESSEE
TN
05
—
3855171
—
TN
05
—
3855172
—
TN
01
—
4150063
BLUE CROSS
TN
01
—
P00199940
RAILROAD MEDICARE
TN
Enumeration date
08/31/2006
Last updated
04/22/2024
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