Provider Demographics
NPI:1295721009
Name:ALBERT, RUBY M (MD)
Entity type:Individual
Prefix:MRS
First Name:RUBY
Middle Name:M
Last Name:ALBERT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MISS
Other - First Name:RUBY
Other - Middle Name:
Other - Last Name:MANIAGO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:4605 MONTICELLO RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29203-4156
Mailing Address - Country:US
Mailing Address - Phone:803-252-7001
Mailing Address - Fax:803-252-5219
Practice Address - Street 1:4605 MONTICELLO RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203-4156
Practice Address - Country:US
Practice Address - Phone:803-252-7001
Practice Address - Fax:803-252-5219
Is Sole Proprietor?:No
Enumeration Date:2005-09-27
Last Update Date:2011-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD39267208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC198182Medicaid
SC198182Medicaid