Provider Demographics
NPI:1639497852
Name:O'FATHAIGH, RUAIDHRI SEOSAMH (MD)
Entity Type:Individual
Prefix:DR
First Name:RUAIDHRI
Middle Name:SEOSAMH
Last Name:O'FATHAIGH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:RUAIRI
Other - Middle Name:JOSEPH
Other - Last Name:FAHY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:22 KINGSTON ROAD
Mailing Address - Street 2:
Mailing Address - City:GALWAY
Mailing Address - State:IRELAND
Mailing Address - Zip Code:00000
Mailing Address - Country:IE
Mailing Address - Phone:01135387-618-8984
Mailing Address - Fax:0113531-410-3549
Practice Address - Street 1:1970 ROANOKE BOULEVARD
Practice Address - Street 2:SALEM VETERAN AFFAIRS MEDICAL CENTER
Practice Address - City:SALEM
Practice Address - State:VA
Practice Address - Zip Code:24153-6404
Practice Address - Country:US
Practice Address - Phone:540-982-2463
Practice Address - Fax:540-983-1049
Is Sole Proprietor?:No
Enumeration Date:2010-05-12
Last Update Date:2010-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.070689207R00000X, 207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0307126Medicaid
OHFA0841551Medicare PIN
OHG39895Medicare UPIN