Provider Demographics
NPI:1205863644
Name:MARRUFO, MANUEL (MD)
Entity Type:Individual
Prefix:DR
First Name:MANUEL
Middle Name:
Last Name:MARRUFO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:MANUEL
Other - Middle Name:
Other - Last Name:MARRUFO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 126
Mailing Address - Street 2:
Mailing Address - City:CHRISTIANSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24068-2147
Mailing Address - Country:US
Mailing Address - Phone:540-951-5090
Mailing Address - Fax:540-951-5094
Practice Address - Street 1:825 DAVIS ST
Practice Address - Street 2:SUITE D
Practice Address - City:BLACKSBURG
Practice Address - State:VA
Practice Address - Zip Code:24060-7013
Practice Address - Country:US
Practice Address - Phone:540-951-5090
Practice Address - Fax:540-951-5094
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2016-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01012385242084N0400X
GA0539952084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAP00319701OtherRAILROAD MEDICARE
NC5905670Medicaid
VA010275091Medicaid
VA1205863644OtherNPI
VAP00319701OtherRAILROAD MEDICARE