Provider Demographics
NPI:1649380635
Name:RUTAN, GALE HELEN (MD)
Entity Type:Individual
Prefix:DR
First Name:GALE
Middle Name:HELEN
Last Name:RUTAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:BRANDYWINE COUNSELING AND COMMUNITY SERVICES
Mailing Address - Street 2:2713 LANCASTER AVE
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19805
Mailing Address - Country:US
Mailing Address - Phone:302-803-0596
Mailing Address - Fax:
Practice Address - Street 1:BRANDYWINE COUNSELING AND COMMUNITY SERVICES
Practice Address - Street 2:2713 LANCASTER AVE.
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19805
Practice Address - Country:US
Practice Address - Phone:302-656-2348
Practice Address - Fax:302-656-8920
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD029863E207R00000X
DEC1-0012420207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DEC1-0012320OtherDELAWARE STATE MEDICAL LICENSE