Provider Demographics
NPI:1629047121
Name:MULLOWNEY-AGRA, RUTH R (MD)
Entity Type:Individual
Prefix:DR
First Name:RUTH
Middle Name:R
Last Name:MULLOWNEY-AGRA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:775 W BROAD ST STE 200
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43222-1471
Mailing Address - Country:US
Mailing Address - Phone:614-627-1610
Mailing Address - Fax:614-228-5040
Practice Address - Street 1:2970 W BROAD ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43204-2649
Practice Address - Country:US
Practice Address - Phone:614-279-0808
Practice Address - Fax:614-279-6111
Is Sole Proprietor?:No
Enumeration Date:2006-03-16
Last Update Date:2022-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35077611207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2264437Medicaid
OH2264437Medicaid
OH4045863Medicare PIN