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General NPI Number Information
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NPI Number | 1760418289
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Entity Type | Individual
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Provider Name | DONALD RUCKER MD
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Gender | Male
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Dates
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Enumeration Date | 06/25/2006
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Last Update Date | 09/02/2025
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Provider Practice Location Address
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Address Line | 9300 DEWITT LOOP
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City | FORT BELVOIR
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State | VA
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Zip | 22060-5285
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Country | US
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Telephone | 571-231-3126
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Fax |
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Provider Business Mailing Address
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Address Line | 2600 CRYSTAL DR APT 1817
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City | ARLINGTON
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State | VA
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Zip | 22202-3579
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Country | US
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Telephone | 617-834-5159
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Fax |
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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 | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 35121102
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | MD070462L
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License Number State | PA
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Taxonomy #3
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 0101272587
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License Number State | VA
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