Provider Demographics
NPI:1376809616
Name:CHAN, RUTH WAI MAN (DO)
Entity Type:Individual
Prefix:DR
First Name:RUTH
Middle Name:WAI MAN
Last Name:CHAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:700 ACKERMAN RD STE 2120
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43202-1559
Mailing Address - Country:US
Mailing Address - Phone:614-293-4837
Mailing Address - Fax:614-293-3125
Practice Address - Street 1:3691 RIDGE MILL DR
Practice Address - Street 2:
Practice Address - City:HILLIARD
Practice Address - State:OH
Practice Address - Zip Code:43026-7752
Practice Address - Country:US
Practice Address - Phone:614-293-4837
Practice Address - Fax:614-293-3125
Is Sole Proprietor?:No
Enumeration Date:2012-04-11
Last Update Date:2022-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34011378207RR0500X
NVDO2107207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0370191Medicaid