Provider Demographics
NPI:1851500151
Name:DANIEL RUTRICK MD PC
Entity Type:Organization
Organization Name:DANIEL RUTRICK MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANGER
Authorized Official - Prefix:
Authorized Official - First Name:EILEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCLELLAN
Authorized Official - Suffix:
Authorized Official - Credentials:OFFICE MANAGER
Authorized Official - Phone:617-387-2220
Mailing Address - Street 1:617 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:MA
Mailing Address - Zip Code:02149-3712
Mailing Address - Country:US
Mailing Address - Phone:617-387-2220
Mailing Address - Fax:617-394-0538
Practice Address - Street 1:617 BROADWAY
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:MA
Practice Address - Zip Code:02149-3712
Practice Address - Country:US
Practice Address - Phone:617-387-2220
Practice Address - Fax:617-394-0538
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2351103T00000X
MA8277103TC1900X
MA142070163WP0809X
MA164216163WP0809X
MA364622084A0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
Not Answered103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Multi-Specialty
Not Answered163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, AdultGroup - Multi-Specialty
Not Answered2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD036462OtherTUFTS GROUP NUMBER
MA500019OtherRUTRICK GROUP PSYCHOLOGIS
MA50064OtherTUFTS CERTIFIED NURSE SPE
MAM13835OtherBLUE SHIELD GROUP NUMBER
MAM13835Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER