1215186465 NPI number — GEBREYE W. RUFAEL, M.D, PA

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215186465 NPI number — GEBREYE W. RUFAEL, M.D, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GEBREYE W. RUFAEL, M.D, PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1215186465
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/11/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10840 LITTLE PATUXENT PKWY
Provider Second Line Business Mailing Address:
302
Provider Business Mailing Address City Name:
COLUMBIA
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21044-3115
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-992-4666
Provider Business Mailing Address Fax Number:
410-992-4766

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10840 LITTLE PATUXENT PKWY
Provider Second Line Business Practice Location Address:
302
Provider Business Practice Location Address City Name:
COLUMBIA
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21044-3115
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-992-4666
Provider Business Practice Location Address Fax Number:
410-992-4766
Provider Enumeration Date:
09/11/2008

Additional Information

Authorized Official

Authorized Official Last Name:
RUFAEL
Authorized Official First Name:
GEBREYE
Authorized Official Middle Name:
W.
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
410-992-4666

Provider Taxonomy Codes

  • Taxonomy code: 261QM2500X , with the licence number:  D17107 , 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: 0-7251-GW-11 . This is a "BLUE SHIELD/BLUE CROSS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 965171301 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3300066 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7680-0001 . This is a "BLUE SHIELD/BLUE CROSS" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".
  • Identifier: 4053583 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 10101242 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".




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