Provider Demographics
NPI:1073674594
Name:MANN, RUTH AVIGAN (MD)
Entity Type:Individual
Prefix:
First Name:RUTH
Middle Name:AVIGAN
Last Name:MANN
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Gender:F
Credentials:MD
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Mailing Address - Street 1:11130 SUNRISE VALLEY DR
Mailing Address - Street 2:SUITE #150
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20191-4398
Mailing Address - Country:US
Mailing Address - Phone:703-262-0100
Mailing Address - Fax:703-262-0333
Practice Address - Street 1:11130 SUNRISE VALLEY DR
Practice Address - Street 2:SUITE #150
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20191-4398
Practice Address - Country:US
Practice Address - Phone:703-262-0100
Practice Address - Fax:703-262-0333
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
VA01010370692080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine