Provider Demographics
NPI:1144775917
Name:KRUTH, BARBARA ELAINE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:BARBARA
Middle Name:ELAINE
Last Name:KRUTH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 BLYMIRE RD
Mailing Address - Street 2:
Mailing Address - City:DALLASTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17313-9220
Mailing Address - Country:US
Mailing Address - Phone:717-244-4531
Mailing Address - Fax:
Practice Address - Street 1:1010 BLYMIRE RD
Practice Address - Street 2:
Practice Address - City:DALLASTOWN
Practice Address - State:PA
Practice Address - Zip Code:17313-9220
Practice Address - Country:US
Practice Address - Phone:717-244-4531
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-22
Last Update Date:2016-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA001750L363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical