Provider Demographics
NPI:1033279690
Name:LAWRENCE, JOHN TODD RUTTER (MD/PHD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:TODD RUTTER
Last Name:LAWRENCE
Suffix:
Gender:M
Credentials:MD/PHD
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Mailing Address - Street 1:100 EAST PENN SQUARE
Mailing Address - Street 2:THE WANAMAKER BUILDING 9TH FL
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-3323
Mailing Address - Country:US
Mailing Address - Phone:267-425-9538
Mailing Address - Fax:267-425-9552
Practice Address - Street 1:34TH & CIVIC CENTER BLVD
Practice Address - Street 2:CHILDREN'S HOSPITAL OF PHILADELPHIA
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-4399
Practice Address - Country:US
Practice Address - Phone:215-590-1527
Practice Address - Fax:215-590-1501
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2013-04-11
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Provider Licenses
StateLicense IDTaxonomies
PAMT181572207X00000X
PAMD427503207XP3100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XP3100XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryPediatric Orthopaedic Surgery
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA100743887-0029Medicaid
PA189479J5NMedicare PIN