Provider Demographics
NPI:1578748737
Name:STEPHANIE DURRUTHY,M.D.,PA
Entity Type:Organization
Organization Name:STEPHANIE DURRUTHY,M.D.,PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:SUSAN
Authorized Official - Last Name:DURRUTHY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-992-0272
Mailing Address - Street 1:5074 DORSEY HALL DR
Mailing Address - Street 2:SUITE 105
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21042-7792
Mailing Address - Country:US
Mailing Address - Phone:410-992-0272
Mailing Address - Fax:410-964-0048
Practice Address - Street 1:5074 DORSEY HALL DR
Practice Address - Street 2:SUITE 105
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21042-7792
Practice Address - Country:US
Practice Address - Phone:410-992-0272
Practice Address - Fax:410-964-0048
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-07
Last Update Date:2008-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD36443261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health