Provider Demographics
NPI:1417928623
Name:RUTH K GALLATIN, MD PA
Entity Type:Organization
Organization Name:RUTH K GALLATIN, MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIANS/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RUTH
Authorized Official - Middle Name:K
Authorized Official - Last Name:GALLATIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-451-7214
Mailing Address - Street 1:2401 BRANDERMILL BLVD STE 220
Mailing Address - Street 2:
Mailing Address - City:GAMBRILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21054-1692
Mailing Address - Country:US
Mailing Address - Phone:410-451-7214
Mailing Address - Fax:410-451-7218
Practice Address - Street 1:2401 BRANDERMILL BLVD
Practice Address - Street 2:SUITE 220
Practice Address - City:GAMBRILLS
Practice Address - State:MD
Practice Address - Zip Code:21054-1690
Practice Address - Country:US
Practice Address - Phone:410-451-7214
Practice Address - Fax:410-451-7218
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-27
Last Update Date:2019-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD405070300Medicaid
0G80RKOtherBCBS
F138OtherBCBS
0G80RKOtherBCBS