Provider Demographics
NPI:1508870882
Name:RUTMAN, MAIA (MD)
Entity Type:Individual
Prefix:
First Name:MAIA
Middle Name:
Last Name:RUTMAN
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:ONE MEDICAL CENTER DRIVE
Mailing Address - Street 2:DARTMOUTH HITCHCOCK MED CTR DEPARTMENT OF PEDIATRICS
Mailing Address - City:LEBANON
Mailing Address - State:NH
Mailing Address - Zip Code:03756-0001
Mailing Address - Country:US
Mailing Address - Phone:603-650-7254
Mailing Address - Fax:603-650-0473
Practice Address - Street 1:ONE MEDICAL CENTER DR
Practice Address - Street 2:DARTMOUTH HITCHCOCK MED CTR EMERGENCY DPTMT
Practice Address - City:LEBNON
Practice Address - State:NH
Practice Address - Zip Code:03756-0001
Practice Address - Country:US
Practice Address - Phone:603-650-7254
Practice Address - Fax:603-650-0473
Is Sole Proprietor?:No
Enumeration Date:2006-07-29
Last Update Date:2008-05-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
RIMD11521208000000X
NH13562208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI7057260Medicaid
RI007057260Medicare ID - Type Unspecified
RI7057260Medicaid