Provider Demographics
NPI:1871568824
Name:RUALO, STEPHEN OLAES (MD)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:OLAES
Last Name:RUALO
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 1:424 SAVANNAH RD
Mailing Address - Street 2:HOSPITALIST DIVISION
Mailing Address - City:LEWES
Mailing Address - State:DE
Mailing Address - Zip Code:19958-1462
Mailing Address - Country:US
Mailing Address - Phone:302-645-3525
Mailing Address - Fax:302-645-3513
Practice Address - Street 1:424 SAVANNAH RD
Practice Address - Street 2:HOSPITALIST DIVISION
Practice Address - City:LEWES
Practice Address - State:DE
Practice Address - Zip Code:19958-1462
Practice Address - Country:US
Practice Address - Phone:302-645-3525
Practice Address - Fax:302-645-3513
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2016-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD63063207R00000X
DEC10009315207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD521116591OtherOPTIMUM CHOICE/MDIPAMAMSI
MD521116591OtherINFORMED
MD64733301OtherCAREFIRST BC/BS RENDERING
MDT5880029OtherCF BC/BS GRP/GHMSI/BL CHO
MD7221697OtherAETNA
MD735736OtherNCPPO
MD521116591OtherTRICARE
MD206948OtherPRIORITY PARTNERS
MD3805180OtherCIGNA
MDP16909OtherCAREFIRST BC/BS POS
MD521116591OtherCOVENTRY
MD521116591OtherMARYLAND PHYSICIANS CARE
MD784381000Medicaid
MDT5880029OtherCF BC/BS GRP/GHMSI/BL CHO
MD521116591OtherTRICARE