Provider Demographics
NPI:1275855926
Name:RUKAB, CHARLIE ALBERT (CNIM)
Entity Type:Individual
Prefix:
First Name:CHARLIE
Middle Name:ALBERT
Last Name:RUKAB
Suffix:
Gender:M
Credentials:CNIM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10420 LITTLE PATUXENT PKWY
Mailing Address - Street 2:SUITE 250
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-3533
Mailing Address - Country:US
Mailing Address - Phone:713-249-6492
Mailing Address - Fax:
Practice Address - Street 1:10420 LITTLE PATUXENT PKWY
Practice Address - Street 2:SUITE 250
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-3533
Practice Address - Country:US
Practice Address - Phone:713-249-6492
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-23
Last Update Date:2012-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1888246ZE0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnostic