Provider Demographics
NPI:1033129218
Name:RUETZEL, CRAIG H (MD)
Entity Type:Individual
Prefix:
First Name:CRAIG
Middle Name:H
Last Name:RUETZEL
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 1:824 GREENBRIER PKWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-3697
Mailing Address - Country:US
Mailing Address - Phone:757-410-7390
Mailing Address - Fax:757-410-7395
Practice Address - Street 1:824 GREENBRIER PKWY
Practice Address - Street 2:SUITE 100
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-3697
Practice Address - Country:US
Practice Address - Phone:757-410-7390
Practice Address - Fax:757-410-7395
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2015-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101048262207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA160001318Medicare PIN
VAF29169Medicare UPIN