Provider Demographics
NPI:1437111648
Name:HOLLIDAY, RUTH M (DO)
Entity Type:Individual
Prefix:DR
First Name:RUTH
Middle Name:M
Last Name:HOLLIDAY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 WESTAGE BUSINESS CTR DR
Mailing Address - Street 2:SUITE 280
Mailing Address - City:FISHKILL
Mailing Address - State:NY
Mailing Address - Zip Code:12524-2260
Mailing Address - Country:US
Mailing Address - Phone:800-835-3723
Mailing Address - Fax:888-847-0818
Practice Address - Street 1:300 WESTAGE BUSINESS CTR DR
Practice Address - Street 2:SUITE 280
Practice Address - City:FISHKILL
Practice Address - State:NY
Practice Address - Zip Code:12524-2260
Practice Address - Country:US
Practice Address - Phone:800-835-3723
Practice Address - Fax:888-847-0818
Is Sole Proprietor?:No
Enumeration Date:2006-04-04
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2523532085R0202X
GA0560702085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1376608513OtherBLUE CROSS
TX50133350OtherTX CONTROLLED SUBSTANCE
GA056070OtherGA MEDICAL LICENSE#
GA919226940HMedicaid
TXK6001OtherTX MEDICAL LICENSE#
TXK6001OtherTX MEDICAL LICENSE#
TXK6001OtherTX MEDICAL LICENSE#
GA056070OtherGA MEDICAL LICENSE#