Provider Demographics
NPI:1053484725
Name:RUTLAND, COSTANZA DIECEKA (MD)
Entity Type:Individual
Prefix:DR
First Name:COSTANZA
Middle Name:DIECEKA
Last Name:RUTLAND
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3998 FAIR RIDGE DR STE 270
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22033-2907
Mailing Address - Country:US
Mailing Address - Phone:703-218-5357
Mailing Address - Fax:703-218-5358
Practice Address - Street 1:3998 FAIR RIDGE DRIVE
Practice Address - Street 2:SUITE 270
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030
Practice Address - Country:US
Practice Address - Phone:703-218-5357
Practice Address - Fax:703-218-5358
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2019-07-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101240864207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology