Basic Information
Provider Information | |||||||||
NPI: | 1376647420 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | MAGRAW | ||||||||
FirstName: | RUTH | ||||||||
MiddleName: | J | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 23 HALLS POINT ROAD | ||||||||
Address2: |   | ||||||||
City: | BRANFORD | ||||||||
State: | CT | ||||||||
PostalCode: | 06405 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2034818990 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 374 GRAND AVENUE | ||||||||
Address2: | FAIR HAVEN COMMUNITY HEALTH CTR | ||||||||
City: | NEW HAVEN | ||||||||
State: | CT | ||||||||
PostalCode: | 06513 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2037777411 | ||||||||
FaxNumber: | 2037778506 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 09/11/2006 | ||||||||
LastUpdateDate: | 07/08/2007 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 026597 | CT | Y |   | Allopathic & Osteopathic Physicians | Pediatrics |   |
ID Information
ID | Type | State | Issuer | Description | 726597 | 01 |   | CF & CARE | OTHER | 010026597CT02 | 01 |   | ATHEM BCBS BLUCARE | OTHER | 1051526 | 01 |   | AETNA US HEALTH | OTHER | 01026597 | 01 |   | CIGNA | OTHER | P804453 | 01 |   | OXFORD | OTHER |