Provider Demographics
NPI:1124215975
Name:TEJEIRA, RUBEN AZRRAEL (MD)
Entity Type:Individual
Prefix:MR
First Name:RUBEN
Middle Name:AZRRAEL
Last Name:TEJEIRA
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 1:22549 LITTLE ST
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:DE
Mailing Address - Zip Code:19947-4759
Mailing Address - Country:US
Mailing Address - Phone:302-854-9006
Mailing Address - Fax:302-854-9716
Practice Address - Street 1:22549 LITTLE ST
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:DE
Practice Address - Zip Code:19947-4759
Practice Address - Country:US
Practice Address - Phone:302-854-9006
Practice Address - Fax:302-854-9716
Is Sole Proprietor?:No
Enumeration Date:2007-09-25
Last Update Date:2010-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC10005053207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DEG50912Medicare UPIN