1639175714 NPI number — DR. GLENN ALDEN RUHL DPM

Table of content: DR. GLENN ALDEN RUHL DPM (NPI 1639175714)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639175714 NPI number — DR. GLENN ALDEN RUHL DPM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RUHL
Provider First Name:
GLENN
Provider Middle Name:
ALDEN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DPM
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1639175714
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
F4 BLACK OAK DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NASHUA
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03062-2910
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-888-8030
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
479 MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WOBURN
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01801-7000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
781-935-3828
Provider Business Practice Location Address Fax Number:
781-932-3252
Provider Enumeration Date:
06/23/2005

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: 213ES0103X , with the licence number:  1642 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 33510 . This is a "HARVARD/PILGRIM PROVIDER" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: Y70710 . This is a "BLUE/CROSS INDIVIDUAL PRO" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 703746 . This is a "TUFTS PROVIDER" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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