Provider Demographics
NPI:1922418516
Name:RUTT, VERONICA (DO)
Entity Type:Individual
Prefix:
First Name:VERONICA
Middle Name:
Last Name:RUTT
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1665 VALLEY CENTER PKWY STE 120
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18017-2353
Mailing Address - Country:US
Mailing Address - Phone:610-868-3150
Mailing Address - Fax:610-868-3156
Practice Address - Street 1:401 N 17TH ST STE 311
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18104-5051
Practice Address - Country:US
Practice Address - Phone:610-969-4470
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-05
Last Update Date:2023-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS019583207ND0101X
MI5101023740207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery