Provider Demographics
NPI:1275767774
Name:RUCKDESCHEL, ELIZABETH A (MD/PHD)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:A
Last Name:RUCKDESCHEL
Suffix:
Gender:F
Credentials:MD/PHD
Other - Prefix:MISS
Other - First Name:ELIZABETH
Other - Middle Name:A
Other - Last Name:PATCHETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:224 HARRISON STREET
Mailing Address - Street 2:STE 600
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13202
Mailing Address - Country:US
Mailing Address - Phone:315-464-6751
Mailing Address - Fax:315-464-6749
Practice Address - Street 1:750 E. ADAMS STREET
Practice Address - Street 2:DEPARTMENT OF PATHOLOGY
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210-2306
Practice Address - Country:US
Practice Address - Phone:315-464-6751
Practice Address - Fax:315-464-6749
Is Sole Proprietor?:No
Enumeration Date:2009-05-12
Last Update Date:2015-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY261284207ZP0102X
390200000X
NY261284-1207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program