Healthcare Provider Details

I. General information

NPI: 1295721009
Provider Name (Legal Business Name): RUBY M ALBERT MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RUBY MANIAGO MD

II. Dates (important events)

Enumeration Date: 09/27/2005
Last Update Date: 03/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4605 MONTICELLO RD
COLUMBIA SC
29203-4156
US

IV. Provider business mailing address

4605 MONTICELLO RD
COLUMBIA SC
29203-4156
US

V. Phone/Fax

Practice location:
  • Phone: 803-252-7001
  • Fax: 803-252-5219
Mailing address:
  • Phone: 803-252-7001
  • Fax: 803-252-5219

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD39267
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: