Provider Demographics
NPI:1366777187
Name:RUDY A SANTOSO MD
Entity type:Organization
Organization Name:RUDY A SANTOSO MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:DR
Authorized Official - First Name:RUDY
Authorized Official - Middle Name:A
Authorized Official - Last Name:SANTOSO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:828-324-4143
Mailing Address - Street 1:1019 LENOIR RHYNE BLVD SE
Mailing Address - Street 2:
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28602-4331
Mailing Address - Country:US
Mailing Address - Phone:828-324-4143
Mailing Address - Fax:828-324-0225
Practice Address - Street 1:1019 LENOIR RHYNE BLVD SE
Practice Address - Street 2:
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28602-4331
Practice Address - Country:US
Practice Address - Phone:828-324-4143
Practice Address - Fax:828-324-0225
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-13
Last Update Date:2009-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC261482084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty