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: 05/30/2025
Certification Date: 05/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

593 EDDY ST
PROVIDENCE RI
02903-4923
US

IV. Provider business mailing address

593 EDDY ST
PROVIDENCE RI
02903-4923
US

V. Phone/Fax

Practice location:
  • Phone: 401-793-2695
  • Fax: 401-444-4165
Mailing address:
  • Phone: 401-793-2695
  • Fax: 401-444-4165

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: