Provider Demographics
NPI:1710188412
Name:RUEHLE, ROY (PAC OGTSUCUABS ASSIS)
Entity Type:Individual
Prefix:
First Name:ROY
Middle Name:
Last Name:RUEHLE
Suffix:
Gender:M
Credentials:PAC OGTSUCUABS ASSIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:406 DONEGAL DRIVE
Mailing Address - Street 2:
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21286
Mailing Address - Country:US
Mailing Address - Phone:410-321-0158
Mailing Address - Fax:
Practice Address - Street 1:2401 WEST BELVEDERE AVE
Practice Address - Street 2:SINAI HOSPITAL
Practice Address - City:BALT
Practice Address - State:MD
Practice Address - Zip Code:21215
Practice Address - Country:US
Practice Address - Phone:410-245-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0001462363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical