Provider Demographics
NPI:1215156534
Name:RUDLOE, ISAAC J (MD)
Entity type:Individual
Prefix:
First Name:ISAAC
Middle Name:J
Last Name:RUDLOE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 BUCKSPORT RD
Mailing Address - Street 2:
Mailing Address - City:ELLSWORTH
Mailing Address - State:ME
Mailing Address - Zip Code:04605-2239
Mailing Address - Country:US
Mailing Address - Phone:207-667-6300
Mailing Address - Fax:
Practice Address - Street 1:128 BUCKSPORT RD
Practice Address - Street 2:
Practice Address - City:ELLSWORTH
Practice Address - State:ME
Practice Address - Zip Code:04605-2239
Practice Address - Country:US
Practice Address - Phone:207-667-6300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-25
Last Update Date:2014-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA231253207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME000220503OtherMEDICARE PTAN