Healthcare Provider Details

I. General information

NPI: 1174889554
Provider Name (Legal Business Name): GUALBERTO RUANO MD, PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2012
Last Update Date: 04/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

67 JEFFERSON ST
HARTFORD CT
06106-2504
US

IV. Provider business mailing address

67 JEFFERSON ST
HARTFORD CT
06106-2504
US

V. Phone/Fax

Practice location:
  • Phone: 860-545-4574
  • Fax:
Mailing address:
  • Phone: 860-545-4574
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0105X
TaxonomyClinical Pathology/Laboratory Medicine Physician
License NumberCL-0644
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: