Provider Demographics
NPI:1972502789
Name:LARUFFA, CATHERINE (MD)
Entity Type:Individual
Prefix:DR
First Name:CATHERINE
Middle Name:
Last Name:LARUFFA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 S BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:BLANCHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:45107-1465
Mailing Address - Country:US
Mailing Address - Phone:937-783-2600
Mailing Address - Fax:937-783-3086
Practice Address - Street 1:700 S BROADWAY ST
Practice Address - Street 2:
Practice Address - City:BLANCHESTER
Practice Address - State:OH
Practice Address - Zip Code:45107-1465
Practice Address - Country:US
Practice Address - Phone:937-783-2600
Practice Address - Fax:937-783-3086
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-14
Last Update Date:2019-10-07
Deactivation Date:2006-03-17
Deactivation Code:
Reactivation Date:2006-03-28
Provider Licenses
StateLicense IDTaxonomies
OH35-061245207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000022715OtherANTHEM BC AND BS
OH0120567OtherUNITED HEALTHCARE
OH0840693Medicaid
OH4384406OtherAETNA
OH61245OtherHUMANA
OH0028777OtherCHAMPUS
OH000000022715OtherANTHEM BC AND BS
OH0120567OtherUNITED HEALTHCARE
OH61245OtherHUMANA