MEDICARE: GLENN A RUHL, DPM, PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213ES0103X	Foot & Ankle Surgery Podiatrist	1642	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	Y77113	OTHER	MA	BLUECROSS GROUP

General Provider Information

NPI Number	:	1447317623
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GLENN A RUHL, DPM, PC

Provider Business Mailing Address
First Line	:	479 MAIN ST
Second Line	:
City	:	WOBURN
State	:	MA
Zip	:	01801-7000
Country	:	US
Telephone Number	:	781-935-3828
Fax Number	:	781-932-3252

Provider Business Practice Location Address
First Line	:	479 MAIN ST
Second Line	:
City	:	WOBURN
State	:	MA
Zip	:	01801-7000
Country	:	US
Telephone Number	:	781-935-3828
Fax Number	:	781-932-3252

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. GLENN A RUHL
Credential	:	DPM
Telephone Number	:	781-935-3828

Provider Enumeration Date	:	01/03/2007
Last Update Date	:	08/22/2020

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