Basic Information
| Provider Information | |||||||||
| NPI: | 1598758054 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GALLATIN | ||||||||
| FirstName: | RUTH | ||||||||
| MiddleName: | K | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2401 BRANDERMILL BLVD STE 220 | ||||||||
| Address2: | |||||||||
| City: | GAMBRILLS | ||||||||
| State: | MD | ||||||||
| PostalCode: | 210541692 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4104517214 | ||||||||
| FaxNumber: | 4104517218 | ||||||||
| Practice Location | |||||||||
| Address1: | 2401 BRANDERMILL BLVD | ||||||||
| Address2: | SUITE 220 | ||||||||
| City: | GAMBRILLS | ||||||||
| State: | MD | ||||||||
| PostalCode: | 210541690 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4104517214 | ||||||||
| FaxNumber: | 4104517218 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/30/2005 | ||||||||
| LastUpdateDate: | 04/26/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | D0052089 | MD | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 33204 | 01 | KAISER | OTHER | 201232800 | 01 | FEDERAL WORKMANS COMP | OTHER | 2573274 | 01 | AETNA PPO | OTHER | 353172 | 01 | MAMSI | OTHER | 54643404 | 01 | BCBS | OTHER | 0001 | 01 | BCBS | OTHER | 129091 | 01 | AETNA HMO | OTHER | 773200700 | 05 | MD | MEDICAID |