Provider Demographics
NPI:1548246176
Name:RUCKI, PAMELA ANN (MD)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:ANN
Last Name:RUCKI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:944 CHERRY ST E
Mailing Address - Street 2:
Mailing Address - City:CANAL FULTON
Mailing Address - State:OH
Mailing Address - Zip Code:44614-8669
Mailing Address - Country:US
Mailing Address - Phone:330-854-4574
Mailing Address - Fax:330-854-0829
Practice Address - Street 1:944 CHERRY ST E
Practice Address - Street 2:
Practice Address - City:CANAL FULTON
Practice Address - State:OH
Practice Address - Zip Code:44614-8669
Practice Address - Country:US
Practice Address - Phone:330-854-4574
Practice Address - Fax:330-854-0829
Is Sole Proprietor?:No
Enumeration Date:2005-12-15
Last Update Date:2020-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35054478R207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH080098366OtherRAILROAD MEDICARE NUMBER
OH0772007Medicaid
OH080098366OtherRAILROAD MEDICARE NUMBER
OHRU0639371Medicare PIN