# GEBREYE W. RUFAEL, M.D, PA

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1215186465
- **Authorized official:** DR. GEBREYE W. RUFAEL M.D (OWNER)
- **Authorized official phone:** (410) 992-4666

## Contact information

- **Practice address:** 10840 LITTLE PATUXENT PKWY, 302, COLUMBIA, MD 21044-3115
- **Practice address phone:** (410) 992-4666
- **Practice address fax:** (410) 992-4766
- **Mailing address:** 10840 LITTLE PATUXENT PKWY, 302, COLUMBIA, MD 21044-3115
- **Mailing address phone:** (410) 992-4666
- **Mailing address fax:** (410) 992-4766

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM2500X | Medical Specialty Clinic/Center | D17107 | MD | Yes |

## Other

- **Enumeration date:** 09/11/2008
- **Last updated:** 09/11/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 0-7251-GW-11 | BLUE SHIELD/BLUE CROSS | MD |
| 01 | — | 10101242 | CIGNA | — |
| 01 | — | 3300066 | UNITED HEALTHCARE | — |
| 01 | — | 4053583 | AETNA | — |
| 01 | — | 7680-0001 | BLUE SHIELD/BLUE CROSS | DC |
| 05 | — | 965171301 | — | MD |