Provider Demographics
NPI:1659317048
Name:RUFAEL, GEBREYE W (MD)
Entity Type:Individual
Prefix:DR
First Name:GEBREYE
Middle Name:W
Last Name:RUFAEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9900 FOX HILL COURT
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21042
Mailing Address - Country:US
Mailing Address - Phone:410-730-2105
Mailing Address - Fax:
Practice Address - Street 1:10840 LITTLE PATUXENT PKY
Practice Address - Street 2:STE 302
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044
Practice Address - Country:US
Practice Address - Phone:410-992-4666
Practice Address - Fax:410-992-4766
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD17107207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
B69718Medicare UPIN
7251Medicare ID - Type Unspecified