Provider Demographics
NPI:1184666521
Name:RUTLEDGE, HAROLD H (MD)
Entity Type:Individual
Prefix:
First Name:HAROLD
Middle Name:H
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:PO BOX 719
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:KY
Mailing Address - Zip Code:42502-0719
Mailing Address - Country:US
Mailing Address - Phone:606-676-0206
Mailing Address - Fax:606-676-0220
Practice Address - Street 1:305 LANGDON ST
Practice Address - Street 2:STE P
Practice Address - City:SOMERSET
Practice Address - State:KY
Practice Address - Zip Code:42503-2750
Practice Address - Country:US
Practice Address - Phone:606-676-0206
Practice Address - Fax:606-676-0220
Is Sole Proprietor?:No
Enumeration Date:2006-06-11
Last Update Date:2014-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY23356208VP0014X, 208VP0000X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYK084250OtherMEDICARE PTAN
KY64233562Medicaid
KYK084250OtherMEDICARE PTAN
KYC67632Medicare UPIN