Provider Demographics
NPI:1871681247
Name:RUTLEDGE, TERESA L (MD)
Entity Type:Individual
Prefix:DR
First Name:TERESA
Middle Name:L
Last Name:RUTLEDGE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:933 BRADBURY DR SE STE 2222
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87106-4375
Mailing Address - Country:US
Mailing Address - Phone:505-925-0461
Mailing Address - Fax:505-925-0454
Practice Address - Street 1:1201 CAMINO DE SALUD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102-4517
Practice Address - Country:US
Practice Address - Phone:505-925-0461
Practice Address - Fax:505-925-0454
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMD2007-0696207VX0201X, 207VX0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0201XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologic Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM28657373Medicaid
NM28657373Medicaid