Provider Demographics
NPI:1497717680
Name:RUCHMAN, MARK C (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:C
Last Name:RUCHMAN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1 RESERVOIR OFFICE PARK STE 203
Mailing Address - Street 2:1449 OLD WATERBURY RD
Mailing Address - City:SOUTHBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06488-3926
Mailing Address - Country:US
Mailing Address - Phone:203-264-4000
Mailing Address - Fax:203-264-4002
Practice Address - Street 1:1 RESERVOIR OFFICE PARK STE 203
Practice Address - Street 2:1449 OLD WATERBURY RD
Practice Address - City:SOUTHBURY
Practice Address - State:CT
Practice Address - Zip Code:06488-3926
Practice Address - Country:US
Practice Address - Phone:203-264-4000
Practice Address - Fax:203-264-4002
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-04
Last Update Date:2016-05-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT022088207W00000X, 207WX0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0200XAllopathic & Osteopathic PhysiciansOphthalmologyOphthalmic Plastic and Reconstructive Surgery
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001220888Medicaid
CT180000706Medicare ID - Type Unspecified
CT001220888Medicaid