Provider Demographics
NPI:1598758054
Name:GALLATIN, RUTH K (MD)
Entity Type:Individual
Prefix:DR
First Name:RUTH
Middle Name:K
Last Name:GALLATIN
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 1:2401 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
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-30
Last Update Date:2019-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0052089207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
33204OtherKAISER
201232800OtherFEDERAL WORKMANS COMP
2573274OtherAETNA PPO
353172OtherMAMSI
54643404OtherBCBS
0001OtherBCBS
129091OtherAETNA HMO
MD773200700Medicaid
110233358Medicare PIN
2573274OtherAETNA PPO
G57268Medicare UPIN