Provider Demographics
NPI:1467532812
Name:RUTOWICZ, DANIEL M (DPM)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:M
Last Name:RUTOWICZ
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 ROSEMARY ST STE B
Mailing Address - Street 2:
Mailing Address - City:NEEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02494-3259
Mailing Address - Country:US
Mailing Address - Phone:781-444-1129
Mailing Address - Fax:718-444-3666
Practice Address - Street 1:145 ROSEMARY ST STE B
Practice Address - Street 2:
Practice Address - City:NEEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02494-3259
Practice Address - Country:US
Practice Address - Phone:781-444-1129
Practice Address - Fax:718-444-3666
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2022-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2069213EP1101X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1261920001OtherDME
MA0307424Medicaid
MA1261920001OtherDME
MALX5296Medicare PIN