Provider Demographics
NPI:1568466316
Name:RUYMANN, FREDERICK W (MD)
Entity Type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:W
Last Name:RUYMANN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:300 MOUNT AUBURN ST
Mailing Address - Street 2:STE 405
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02138-5502
Mailing Address - Country:US
Mailing Address - Phone:617-661-0221
Mailing Address - Fax:617-661-3862
Practice Address - Street 1:300 MOUNT AUBURN ST
Practice Address - Street 2:STE 405
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02138-5665
Practice Address - Country:US
Practice Address - Phone:617-661-0221
Practice Address - Fax:617-661-3862
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-09
Last Update Date:2012-01-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA71422207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3052788Medicaid
MAE17583Medicare UPIN
MAJ0894302Medicare PIN