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General NPI Number Information
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NPI Number | 1316194541
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Entity Type | Organization
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Legal Business Name | N.T. RUELOS, M.D., P.C.
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Dates
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Enumeration Date | 08/19/2008
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Last Update Date | 04/29/2013
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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 | OWNER/PRESIDENT
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Name | DR. NELLIE T RUELOS
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Credential | M.D.
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Telephone | 410-552-9004
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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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