Provider Demographics
NPI:1215186465
Name:GEBREYE W. RUFAEL, M.D, PA
Entity Type:Organization
Organization Name:GEBREYE W. RUFAEL, M.D, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GEBREYE
Authorized Official - Middle Name:W
Authorized Official - Last Name:RUFAEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-992-4666
Mailing Address - Street 1:10840 LITTLE PATUXENT PKWY
Mailing Address - Street 2:302
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-3115
Mailing Address - Country:US
Mailing Address - Phone:410-992-4666
Mailing Address - Fax:410-992-4766
Practice Address - Street 1:10840 LITTLE PATUXENT PKWY
Practice Address - Street 2:302
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-3115
Practice Address - Country:US
Practice Address - Phone:410-992-4666
Practice Address - Fax:410-992-4766
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-11
Last Update Date:2008-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD17107261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD0-7251-GW-11OtherBLUE SHIELD/BLUE CROSS
MD965171301Medicaid
3300066OtherUNITED HEALTHCARE
DC7680-0001OtherBLUE SHIELD/BLUE CROSS
4053583OtherAETNA
10101242OtherCIGNA
B69718Medicare UPIN
7251Medicare PIN