Provider Demographics
NPI:1073563540
Name:RUTTENBERG, NORMAN F (DO)
Entity Type:Individual
Prefix:
First Name:NORMAN
Middle Name:F
Last Name:RUTTENBERG
Suffix:
Gender:M
Credentials:DO
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 820137
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19182-0137
Mailing Address - Country:US
Mailing Address - Phone:610-270-2355
Mailing Address - Fax:610-270-2358
Practice Address - Street 1:559 W GERMANTOWN PIKE
Practice Address - Street 2:
Practice Address - City:EAST NORRITON
Practice Address - State:PA
Practice Address - Zip Code:19403-4250
Practice Address - Country:US
Practice Address - Phone:484-622-0700
Practice Address - Fax:484-622-0643
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2012-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS002362L2085N0700X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA041868OtherHIGHMARK BLUE SHIELD
PA300138321OtherRRM
PA0057244000OtherIBC - PC/KHPE
PA30005645OtherKEYSTONE MERCY
PA4294628OtherAETNA
PA00574244000OtherAMERIHEALTH/INTERCOUNTY
PA08722-OS002362LOtherHEALTH PARTNERS
PA5654278OtherCIGNA HMO/PPO
PA0006414180003Medicaid
PA0064141804OtherAMERICHOICE (UHC MA PLAN)
PA0006414180003Medicaid
PA041868OtherHIGHMARK BLUE SHIELD