Individual
LEONARD M. RUDOLF
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D
Contact information
Practice address
17 ALICE PECK DAY DR UNIT C, LEBANON, NH 03766-2684
(603) 448-6344
(603) 448-3405
Mailing address
10 ALICE PECK DAY DR, LEBANON, NH 03766-2694
(603) 448-3121
(603) 448-7462
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
0420007597
VT
207X00000X
Orthopaedic Surgery Physician
Primary
7449
NH
207XS0117X
Orthopaedic Surgery of the Spine Physician
7449
NH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0009184
—
VT
05
—
30207509
—
NH
01
—
NH0016
MEDICARE PTAN
NH
01
—
VN224302
MEDICARE B PTAN
NH
Enumeration date
12/22/2005
Last updated
05/08/2017
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