Provider Demographics
NPI:1467719021
Name:RUTLEDGE, ISAAC W (MED)
Entity Type:Individual
Prefix:MR
First Name:ISAAC
Middle Name:W
Last Name:RUTLEDGE
Suffix:
Gender:M
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:73 CONGRESS ST
Mailing Address - Street 2:105
Mailing Address - City:SALEM
Mailing Address - State:MA
Mailing Address - Zip Code:01970-5509
Mailing Address - Country:US
Mailing Address - Phone:978-740-1500
Mailing Address - Fax:978-741-3104
Practice Address - Street 1:73 CONGRESS ST
Practice Address - Street 2:105
Practice Address - City:SALEM
Practice Address - State:MA
Practice Address - Zip Code:01970-5509
Practice Address - Country:US
Practice Address - Phone:978-740-1500
Practice Address - Fax:978-741-3104
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-19
Last Update Date:2012-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA101YA0400X101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)