Healthcare Provider Details

I. General information

NPI: 1053606285
Provider Name (Legal Business Name): JENNY MEI RUAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2011
Last Update Date: 05/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 WASHINGTON ST BOX 324
BOSTON MA
02111-1552
US

IV. Provider business mailing address

800 WASHINGTON ST BOX 324
BOSTON MA
02111-1552
US

V. Phone/Fax

Practice location:
  • Phone: 617-636-2382
  • Fax:
Mailing address:
  • Phone: 617-636-2382
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number248430
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: