Provider Demographics
NPI:1902800766
Name:RUFFOLO, THOMAS (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:
Last Name:RUFFOLO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:606 E 12TH ST
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27889-3408
Mailing Address - Country:US
Mailing Address - Phone:252-946-1573
Mailing Address - Fax:252-946-1573
Practice Address - Street 1:606 E 12TH ST
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:NC
Practice Address - Zip Code:27889-3408
Practice Address - Country:US
Practice Address - Phone:252-946-1573
Practice Address - Fax:252-946-1316
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2022-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC34150207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2160007AMedicare ID - Type Unspecified
NC8973924Medicare ID - Type Unspecified
NCE41975Medicare UPIN