Provider Demographics
NPI:1588222889
Name:RUTHERFORD, EUSTACE OSWIN JR
Entity Type:Individual
Prefix:
First Name:EUSTACE
Middle Name:OSWIN
Last Name:RUTHERFORD
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4226 SOUTHERN AVE SE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20019-5630
Mailing Address - Country:US
Mailing Address - Phone:202-593-2309
Mailing Address - Fax:
Practice Address - Street 1:4226 SOUTHERN AVE SE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20019-5630
Practice Address - Country:US
Practice Address - Phone:202-248-9040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-31
Last Update Date:2019-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant