Individual
JANE ELIZABETH RUDOLPH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
179 ROSELAND AVE, WATERBURY, CT 06710
(203) 574-4747
(203) 574-2251
Mailing address
179 ROSELAND AVE, WATERBURY, CT 06710
(203) 574-4747
(203) 574-2251
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
023752
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001237528
—
CT
01
—
00123752800
BCFP
CT
01
—
0K0607
HN
CT
Enumeration date
08/09/2006
Last updated
06/22/2021
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