Provider Demographics
NPI:1093883662
Name:RUVINSKY, MARCELO J (MD)
Entity Type:Individual
Prefix:
First Name:MARCELO
Middle Name:J
Last Name:RUVINSKY
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 1:1010 LAKELAND SQUARE EXT
Mailing Address - Street 2:SUITE A
Mailing Address - City:FLOWOOD
Mailing Address - State:MS
Mailing Address - Zip Code:39232-7607
Mailing Address - Country:US
Mailing Address - Phone:601-981-1610
Mailing Address - Fax:601-366-2887
Practice Address - Street 1:1010 LAKELAND SQUARE EXT
Practice Address - Street 2:SUITE A
Practice Address - City:FLOWOOD
Practice Address - State:MS
Practice Address - Zip Code:39232-7607
Practice Address - Country:US
Practice Address - Phone:601-981-1610
Practice Address - Fax:601-366-2887
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2010-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS4790207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00015941Medicaid
MS00015941Medicaid
B30965Medicare UPIN