1275767774 NPI number — DR. ELIZABETH A. RUCKDESCHEL M.D./PH.D.

Table of content: DR. ELIZABETH A. RUCKDESCHEL M.D./PH.D. (NPI 1275767774)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275767774 NPI number — DR. ELIZABETH A. RUCKDESCHEL M.D./PH.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RUCKDESCHEL
Provider First Name:
ELIZABETH
Provider Middle Name:
A.
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D./PH.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PATCHETT
Provider Other First Name:
ELIZABETH
Provider Other Middle Name:
A.
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1275767774
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/04/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
224 HARRISON STREET
Provider Second Line Business Mailing Address:
STE 600
Provider Business Mailing Address City Name:
SYRACUSE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
13202
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
315-464-6751
Provider Business Mailing Address Fax Number:
315-464-6749

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
750 E. ADAMS STREET
Provider Second Line Business Practice Location Address:
DEPARTMENT OF PATHOLOGY
Provider Business Practice Location Address City Name:
SYRACUSE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13210-2306
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-464-6751
Provider Business Practice Location Address Fax Number:
315-464-6749
Provider Enumeration Date:
05/12/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207ZP0102X , with the licence number:  261284 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207ZP0102X , with the licence number: 261284-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)