Provider Demographics
NPI:1801845961
Name:RUTKOWSKI, ROBERT (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:RUTKOWSKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:663 SUNSET LN
Mailing Address - Street 2:
Mailing Address - City:CULPEPER
Mailing Address - State:VA
Mailing Address - Zip Code:22701-3919
Mailing Address - Country:US
Mailing Address - Phone:540-825-5362
Mailing Address - Fax:540-829-0420
Practice Address - Street 1:663 SUNSET LN
Practice Address - Street 2:
Practice Address - City:CULPEPER
Practice Address - State:VA
Practice Address - Zip Code:22701-3919
Practice Address - Country:US
Practice Address - Phone:540-825-5362
Practice Address - Fax:540-829-0420
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2014-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101033374207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
200000219Medicare ID - Type Unspecified
B09388Medicare UPIN
VA0662830001Medicare NSC