Provider Demographics
NPI:1013009299
Name:VOGEL, RUTH (MD)
Entity Type:Individual
Prefix:DR
First Name:RUTH
Middle Name:
Last Name:VOGEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4624 PEMBROKE BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23455-6450
Mailing Address - Country:US
Mailing Address - Phone:757-490-3331
Mailing Address - Fax:757-490-3055
Practice Address - Street 1:4624 PEMBROKE BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23455-6450
Practice Address - Country:US
Practice Address - Phone:757-490-3331
Practice Address - Fax:757-490-3055
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101040482174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA006743111Medicaid
VAF76945Medicare UPIN