Provider Demographics
NPI:1326030214
Name:RUTKOWSKI, JANICE F (MD)
Entity Type:Individual
Prefix:DR
First Name:JANICE
Middle Name:F
Last Name:RUTKOWSKI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:7580 BUCKINGHAM BLVD
Mailing Address - Street 2:SUITE 220
Mailing Address - City:HANOVER
Mailing Address - State:MD
Mailing Address - Zip Code:21076-3002
Mailing Address - Country:US
Mailing Address - Phone:410-729-5100
Mailing Address - Fax:
Practice Address - Street 1:7556 TEAGUE RD.
Practice Address - Street 2:SUITE 210
Practice Address - City:HANOVER
Practice Address - State:MD
Practice Address - Zip Code:21076
Practice Address - Country:US
Practice Address - Phone:410-551-0499
Practice Address - Fax:410-799-9070
Is Sole Proprietor?:No
Enumeration Date:2005-08-17
Last Update Date:2020-04-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD0027513207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD420210-10OtherCAREFIRST MD RENDERING
MD7605-0030OtherCAREFIRST BLUECHOICE
MD8163609OtherMAMSI PRIMARY CARE
MD0000611OtherAETNA CAPITATED
MD2163609OtherMAMSI SPECIALIST
MD586100400Medicaid
MDP12793OtherCAREFIRST MPOS
MD036584OtherJHHC PROVIDER NUMBER
MD110179667OtherRR MEDICARE
MD4137394OtherAETNA FEE FOR SERVICE
MD1402555OtherCIGNA PIN
B70957Medicare UPIN
MD586100400Medicaid