Provider Demographics
NPI:1063687598
Name:MEDINA GUTIERREZ, RUTH ELIZABETH (MD)
Entity Type:Individual
Prefix:
First Name:RUTH
Middle Name:ELIZABETH
Last Name:MEDINA GUTIERREZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 MALL ROAD
Mailing Address - Street 2:LAHEY HOSPITAL AND MEDICAL CENTER
Mailing Address - City:BURLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01805-0001
Mailing Address - Country:US
Mailing Address - Phone:781-744-3839
Mailing Address - Fax:781-744-1597
Practice Address - Street 1:41 MALL ROAD
Practice Address - Street 2:LAHEY HOSPITAL AND MEDICAL CENTER
Practice Address - City:BURLINGTON
Practice Address - State:MA
Practice Address - Zip Code:01805-0001
Practice Address - Country:US
Practice Address - Phone:781-744-3839
Practice Address - Fax:781-744-1597
Is Sole Proprietor?:No
Enumeration Date:2008-04-25
Last Update Date:2016-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA246451174400000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No174400000XOther Service ProvidersSpecialist