Healthcare Provider Details

I. General information

NPI: 1225097058
Provider Name (Legal Business Name): PHILIP JOHN RUZBARSKY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/21/2006
Last Update Date: 04/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 AIRPORT DR SUITE 34
WESTMINSTER MD
21157-3024
US

IV. Provider business mailing address

125 AIRPORT DR SUITE 34
WESTMINSTER MD
21157-3024
US

V. Phone/Fax

Practice location:
  • Phone: 410-848-8882
  • Fax: 410-848-8767
Mailing address:
  • Phone: 410-848-8882
  • Fax: 410-848-8768

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberD33599
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: