Provider Demographics
NPI:1093762031
Name:RUFFETT, DONALD S (MD)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:S
Last Name:RUFFETT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:345 N MAIN ST FL 1
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06117-2515
Mailing Address - Country:US
Mailing Address - Phone:860-547-1489
Mailing Address - Fax:860-548-9105
Practice Address - Street 1:345 N MAIN ST FL 1
Practice Address - Street 2:
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06117-2515
Practice Address - Country:US
Practice Address - Phone:860-547-1489
Practice Address - Fax:860-548-9105
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2015-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT018615207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001186154Medicaid
CT001186154Medicaid
CT060001227Medicare ID - Type Unspecified