Healthcare Provider Details

I. General information

NPI: 1568466316
Provider Name (Legal Business Name): FREDERICK W RUYMANN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2005
Last Update Date: 01/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 MOUNT AUBURN ST STE 405
CAMBRIDGE MA
02138-5665
US

IV. Provider business mailing address

300 MOUNT AUBURN ST STE 405
CAMBRIDGE MA
02138-5502
US

V. Phone/Fax

Practice location:
  • Phone: 617-661-0221
  • Fax: 617-661-3862
Mailing address:
  • Phone: 617-661-0221
  • Fax: 617-661-3862

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number71422
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: