Individual
RUDOLPH B. RUSTIN III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1300 JEFFERSON PARK AVE, 4TH FLOOR, CHARLOTTESVILLE, VA 22903-3363
(434) 982-4411
(434) 924-2260
Mailing address
PO BOX 9007, CHARLOTTESVILLE, VA 22906-9007
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
0101258483
VA
208600000X
Surgery Physician
14302
SC
208C00000X
Colon & Rectal Surgery Physician
14302
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
143026
—
SC
05
—
1679548614
—
VA
Enumeration date
02/22/2006
Last updated
09/09/2016
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