Provider Demographics
NPI:1053439364
Name:RUDOLPH MEDICAL ASSOCIATES, PA
Entity type:Organization
Organization Name:RUDOLPH MEDICAL ASSOCIATES, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TRAM
Authorized Official - Middle Name:NGOC
Authorized Official - Last Name:HO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-457-5500
Mailing Address - Street 1:12924 BELLAIRE BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77072-5132
Mailing Address - Country:US
Mailing Address - Phone:713-457-5500
Mailing Address - Fax:713-457-4200
Practice Address - Street 1:12924 BELLAIRE BLVD STE 100
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77072-5132
Practice Address - Country:US
Practice Address - Phone:713-457-5500
Practice Address - Fax:713-457-4200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2014-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX176386401Medicaid
TX176386401Medicaid