Healthcare Provider Details

I. General information

NPI: 1609679018
Provider Name (Legal Business Name): VICTORIA RUVKUN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2025
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

759 CHESTNUT ST
SPRINGFIELD MA
01199-1001
US

IV. Provider business mailing address

759 CHESTNUT ST
SPRINGFIELD MA
01199-1001
US

V. Phone/Fax

Practice location:
  • Phone: 413-794-0884
  • Fax: 413-794-0300
Mailing address:
  • Phone: 413-794-0884
  • Fax: 413-794-0300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberLP06680
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: