Provider Demographics
NPI:1396342556
Name:RUCKER, RALPH CHISTOPHER
Entity type:Individual
Prefix:MR
First Name:RALPH
Middle Name:CHISTOPHER
Last Name:RUCKER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 221
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:OH
Mailing Address - Zip Code:43105-0221
Mailing Address - Country:US
Mailing Address - Phone:161-420-3169
Mailing Address - Fax:
Practice Address - Street 1:11395 LANC KIRK RD NW
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:OH
Practice Address - Zip Code:43105-9630
Practice Address - Country:US
Practice Address - Phone:614-203-1695
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-01
Last Update Date:2020-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0114821253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care