=====================================================
General NPI Number Information
=====================================================
NPI Number | 1942647953
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ELANA RACHEL RYBAK DVM
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/30/2013
-----------------------------------------------------
Last Update Date | 05/30/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10 S PINE ST MSTF BLDG, ROOM 469
-----------------------------------------------------
City | BALTIMORE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21201-1116
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-706-1164
-----------------------------------------------------
Fax | 410-706-0311
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 941 N CALVERT ST APT 1R
-----------------------------------------------------
City | BALTIMORE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21202-3730
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 517-285-0041
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174M00000X
-----------------------------------------------------
Taxonomy Name | Veterinarian
-----------------------------------------------------
License Number | 6670
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------