MEDICARE: DR. MARK C RUCHMAN M.D.

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	207W00000X	Ophthalmology Physician	022088	CT
2	207WX0200X	Ophthalmic Plastic and Reconstructive Surgery Physician	022088	CT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1497717680
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK C RUCHMAN M.D.

Provider Business Mailing Address
First Line	:	1 RESERVOIR OFFICE PARK STE 203
Second Line	:	1449 OLD WATERBURY RD
City	:	SOUTHBURY
State	:	CT
Zip	:	06488-3926
Country	:	US
Telephone Number	:	203-264-4000
Fax Number	:	203-264-4002

Provider Business Practice Location Address
First Line	:	1 RESERVOIR OFFICE PARK STE 203
Second Line	:	1449 OLD WATERBURY RD
City	:	SOUTHBURY
State	:	CT
Zip	:	06488-3926
Country	:	US
Telephone Number	:	203-264-4000
Fax Number	:	203-264-4002

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/04/2006
Last Update Date	:	05/06/2016

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