Healthcare Provider Details

I. General information

NPI: 1386878254
Provider Name (Legal Business Name): KELLY ELIZABETH RUHSTALLER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2009
Last Update Date: 08/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 CENTURIAN DR SUITE 312
NEWARK DE
19713-2137
US

IV. Provider business mailing address

1 CENTURIAN DR SUITE 312
NEWARK DE
19713-2137
US

V. Phone/Fax

Practice location:
  • Phone: 302-319-5680
  • Fax: 302-319-5681
Mailing address:
  • Phone: 302-319-5680
  • Fax: 302-319-5681

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License NumberC1-0011761
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: