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

Table of content: (NPI 1215186465)

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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