Provider Demographics
NPI:1043615057
Name:M RUTH INFANTE MD PC
Entity Type:Organization
Organization Name:M RUTH INFANTE MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY
Authorized Official - Middle Name:RUTH
Authorized Official - Last Name:INFANTE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-575-8101
Mailing Address - Street 1:1500 N. BEAUREGARD ST,
Mailing Address - Street 2:SUITE 240
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22311-1715
Mailing Address - Country:US
Mailing Address - Phone:703-575-8101
Mailing Address - Fax:703-575-8373
Practice Address - Street 1:1500 N. BEAUREGARD ST,
Practice Address - Street 2:SUITE 240
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22311-1715
Practice Address - Country:US
Practice Address - Phone:703-575-8101
Practice Address - Fax:703-575-8373
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-03
Last Update Date:2015-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101-0465372084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA7101309Medicaid
VAE99163Medicare UPIN
VA260022421Medicare PIN
VAC07082Medicare PIN
DC436314Medicare PIN
DC688281S14Medicare PIN
VA260003039Medicare PIN
VA7101309Medicaid
VAM8508Medicare PIN