Provider Demographics
NPI:1083939623
Name:RUTLEDGE, GEOFFREY MERRITT (MD)
Entity Type:Individual
Prefix:DR
First Name:GEOFFREY
Middle Name:MERRITT
Last Name:RUTLEDGE
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 1:354 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02139-1738
Mailing Address - Country:US
Mailing Address - Phone:651-890-7024
Mailing Address - Fax:
Practice Address - Street 1:1100 9TH AVE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98101-2756
Practice Address - Country:US
Practice Address - Phone:206-223-6851
Practice Address - Fax:206-223-6816
Is Sole Proprietor?:No
Enumeration Date:2010-04-06
Last Update Date:2022-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2548602085R0202X
ORMD1840782085R0202X
WAMD607516932085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500727834Medicaid
WA2079666Medicaid