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General NPI Number Information
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NPI Number | 1215186465
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Entity Type | Organization
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Legal Business Name | GEBREYE W. RUFAEL, M.D, PA
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Dates
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Enumeration Date | 09/11/2008
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Last Update Date | 09/11/2008
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Provider Practice Location Address
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Address Line | 10840 LITTLE PATUXENT PKWY 302
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City | COLUMBIA
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State | MD
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Zip | 21044-3115
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Country | US
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Telephone | 410-992-4666
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Fax | 410-992-4766
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Provider Business Mailing Address
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Address Line | 10840 LITTLE PATUXENT PKWY 302
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City | COLUMBIA
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State | MD
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Zip | 21044-3115
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Country | US
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Telephone | 410-992-4666
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Fax | 410-992-4766
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Authorized Official
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Title or Position | OWNER
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Name | DR. GEBREYE W. RUFAEL
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Credential | M.D
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Telephone | 410-992-4666
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | D17107
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License Number State | MD
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