Healthcare Provider Details

I. General information

NPI: 1215186465
Provider Name (Legal Business Name): GEBREYE W. RUFAEL, M.D, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2008
Last Update Date: 09/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10840 LITTLE PATUXENT PKWY 302
COLUMBIA MD
21044-3115
US

IV. Provider business mailing address

10840 LITTLE PATUXENT PKWY 302
COLUMBIA MD
21044-3115
US

V. Phone/Fax

Practice location:
  • Phone: 410-992-4666
  • Fax: 410-992-4766
Mailing address:
  • Phone: 410-992-4666
  • Fax: 410-992-4766

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License NumberD17107
License Number StateMD

VIII. Authorized Official

Name: DR. GEBREYE W. RUFAEL
Title or Position: OWNER
Credential: M.D
Phone: 410-992-4666