Provider Demographics
NPI:1700837192
Name:RUTZEN, ALLAN R (MD)
Entity Type:Individual
Prefix:DR
First Name:ALLAN
Middle Name:R
Last Name:RUTZEN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:489 RITCHIE HIGHWAY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SEVERNA PARK
Mailing Address - State:MD
Mailing Address - Zip Code:21146-2910
Mailing Address - Country:US
Mailing Address - Phone:410-975-0090
Mailing Address - Fax:410-975-0089
Practice Address - Street 1:489 RITCHIE HIGHWAY
Practice Address - Street 2:STE 200
Practice Address - City:SEVERNA PARK
Practice Address - State:MD
Practice Address - Zip Code:21146-2944
Practice Address - Country:US
Practice Address - Phone:410-975-0090
Practice Address - Fax:410-975-0089
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2012-12-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MDD0051102207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
F62575Medicare UPIN