Provider Demographics
NPI:1952392524
Name:RUSKIN, JEREMY NEIL (MD)
Entity Type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:NEIL
Last Name:RUSKIN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 9142
Mailing Address - Street 2:MASS GENERAL PHYSICIAN ORGANIZATION
Mailing Address - City:CHARLESTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02129-9142
Mailing Address - Country:US
Mailing Address - Phone:617-726-8514
Mailing Address - Fax:617-724-6747
Practice Address - Street 1:55 FRUIT ST
Practice Address - Street 2:BIGELOW 109 ELECTROPHYSIOLOGY LAB ARRHYTHMIA SERVICE
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2696
Practice Address - Country:US
Practice Address - Phone:617-726-8514
Practice Address - Fax:617-724-6747
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2014-07-03
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Provider Licenses
StateLicense IDTaxonomies
MA35328207R00000X, 207RC0000X, 207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2056224Medicaid
MAM09577OtherBCBS MA
MA034328OtherTUFTS HEALTH PLAN
MAM09577OtherBCBS MA
B76673Medicare UPIN