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General NPI Number Information
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NPI Number | 1225073885
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Entity Type | Individual
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Provider Name | NELLIE T RUELOS M.D.
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Gender | Female
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Dates
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Enumeration Date | 06/18/2006
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Last Update Date | 04/28/2013
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Provider Practice Location Address
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Address Line | 1643 LIBERTY RD STE. 204
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City | ELDERSBURG
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State | MD
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Zip | 21784-6544
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Country | US
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Telephone | 410-552-9004
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Fax | 410-552-9003
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Provider Business Mailing Address
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Address Line | 1421 WOODRIDGE LN
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City | ELDERSBURG
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State | MD
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Zip | 21784-8338
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Country | US
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Telephone | 410-552-9983
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Fax | 410-552-9984
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | D30381
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number | D30381
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License Number State | MD
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