Provider Demographics
NPI:1326072661
Name:RUFF, ROY L (MD)
Entity Type:Individual
Prefix:DR
First Name:ROY
Middle Name:L
Last Name:RUFF
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 1:75 HERRICK STREET, SUITE 116
Mailing Address - Street 2:NORTH SHORE PREVENTIVE HEALTH CARE, PC
Mailing Address - City:BEVERLY
Mailing Address - State:MA
Mailing Address - Zip Code:01915
Mailing Address - Country:US
Mailing Address - Phone:978-922-5200
Mailing Address - Fax:978-922-5210
Practice Address - Street 1:77 HERRICK STREET
Practice Address - Street 2:SUITE 101
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915
Practice Address - Country:US
Practice Address - Phone:978-922-5200
Practice Address - Fax:978-922-5210
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2013-09-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA45310207R00000X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0113596Medicaid
MA0113596Medicaid
MAB97365Medicare UPIN
MAD03107Medicare PIN