Provider Demographics
NPI:1225073885
Name:RUELOS, NELLIE T (MD)
Entity Type:Individual
Prefix:DR
First Name:NELLIE
Middle Name:T
Last Name:RUELOS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:1421 WOODRIDGE LN
Mailing Address - Street 2:
Mailing Address - City:ELDERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:21784-8338
Mailing Address - Country:US
Mailing Address - Phone:410-552-9983
Mailing Address - Fax:410-552-9984
Practice Address - Street 1:1643 LIBERTY RD
Practice Address - Street 2:STE. 204
Practice Address - City:ELDERSBURG
Practice Address - State:MD
Practice Address - Zip Code:21784-6544
Practice Address - Country:US
Practice Address - Phone:410-552-9004
Practice Address - Fax:410-552-9003
Is Sole Proprietor?:No
Enumeration Date:2006-06-18
Last Update Date:2013-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD303812084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD383631200Medicaid
MD383631200Medicaid
MD935FMedicare PIN