Provider Demographics
NPI:1225027089
Name:KING, RUTH G (MD)
Entity Type:Individual
Prefix:DR
First Name:RUTH
Middle Name:G
Last Name:KING
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:PO BOX 202
Mailing Address - Street 2:516 PLYMOUTH RD.
Mailing Address - City:GWYNEDD VALLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19437-0202
Mailing Address - Country:US
Mailing Address - Phone:203-687-6580
Mailing Address - Fax:215-646-0518
Practice Address - Street 1:26 SOUTH 40TH STR.
Practice Address - Street 2:CHILDREN'S BEHAVIORAL HEALTH SERVICES
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104
Practice Address - Country:US
Practice Address - Phone:215-596-8300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-14
Last Update Date:2010-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0348842084P0804X
PAMD4388352084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001294636Medicaid
CT260003473Medicare ID - Type Unspecified
CT001294636Medicaid