Provider Demographics
NPI:1679917512
Name:EGDON, RUTH (RMP)
Entity Type:Individual
Prefix:
First Name:RUTH
Middle Name:
Last Name:EGDON
Suffix:
Gender:F
Credentials:RMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7954 B AND A BLVD
Mailing Address - Street 2:SUITE 2K
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21060-8188
Mailing Address - Country:US
Mailing Address - Phone:410-787-0044
Mailing Address - Fax:
Practice Address - Street 1:7954 B AND A BLVD
Practice Address - Street 2:SUITE 2K
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21060-8188
Practice Address - Country:US
Practice Address - Phone:410-787-0044
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-22
Last Update Date:2013-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR00932225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist