Provider Demographics
NPI:1174558183
Name:RUFF, JOHN CULLEN (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:CULLEN
Last Name:RUFF
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:J
Other - Middle Name:CULLEN
Other - Last Name:RUFF
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:2722 MERRILEE DR
Mailing Address - Street 2:STE 230
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-4400
Mailing Address - Country:US
Mailing Address - Phone:703-698-4483
Mailing Address - Fax:
Practice Address - Street 1:2722 MERRILEE DR
Practice Address - Street 2:#230
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-4400
Practice Address - Country:US
Practice Address - Phone:703-698-4498
Practice Address - Fax:703-573-0800
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2020-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01010592512085B0100X, 2085N0700X, 2085N0904X, 2085R0202X, 2085P0229X, 2085R0204X, 2085U0001X
MDD00876262085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody Imaging
No2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
No2085N0904XAllopathic & Osteopathic PhysiciansRadiologyNuclear Radiology
No2085P0229XAllopathic & Osteopathic PhysiciansRadiologyPediatric Radiology
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Ultrasound
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0045OtherCAREFIRST
WV72200895000Medicaid
WV72200895000Medicaid
VAP00296650Medicare PIN
VA0045OtherCAREFIRST
VA300099470Medicare PIN
VA300099473Medicare PIN
DC004381F43Medicare PIN