Provider Demographics
NPI:1376791202
Name:LOTZ, RUTH JOHANNA (MD)
Entity Type:Individual
Prefix:
First Name:RUTH
Middle Name:JOHANNA
Last Name:LOTZ
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 1:301 KILDAIRE RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27516-4064
Mailing Address - Country:US
Mailing Address - Phone:919-967-0771
Mailing Address - Fax:919-967-9207
Practice Address - Street 1:301 KILDAIRE RD
Practice Address - Street 2:SUITE 200
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27516-4064
Practice Address - Country:US
Practice Address - Phone:919-967-0771
Practice Address - Fax:919-967-9207
Is Sole Proprietor?:No
Enumeration Date:2008-09-04
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200200947208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89132J7Medicaid
H68921OtherUPIN