1376647420 NPI number — RUTH J MAGRAW MD

Table of content: RUTH J MAGRAW MD (NPI 1376647420)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376647420 NPI number — RUTH J MAGRAW MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MAGRAW
Provider First Name:
RUTH
Provider Middle Name:
J
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

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:
1376647420
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:
23 HALLS POINT ROAD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BRANFORD
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06405
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-481-8990
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
374 GRAND AVENUE
Provider Second Line Business Practice Location Address:
FAIR HAVEN COMMUNITY HEALTH CTR
Provider Business Practice Location Address City Name:
NEW HAVEN
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06513
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-777-7411
Provider Business Practice Location Address Fax Number:
203-777-8506
Provider Enumeration Date:
09/11/2006

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: 208000000X , with the licence number:  026597 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 726597 . This is a "CF & CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 010026597CT02 . This is a "ATHEM BCBS BLUCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1051526 . This is a "AETNA US HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 01026597 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: P804453 . This is a "OXFORD" identifier . This identifiers is of the category "OTHER".




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