Provider Demographics
NPI:1023482965
Name:RUETZEL GYNECOLOGY & OBSTETRICS
Entity type:Organization
Organization Name:RUETZEL GYNECOLOGY & OBSTETRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:H
Authorized Official - Last Name:RUETZEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:757-410-7390
Mailing Address - Street 1:824 GREENBRIER PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-3697
Mailing Address - Country:US
Mailing Address - Phone:757-410-7390
Mailing Address - Fax:757-410-7395
Practice Address - Street 1:824 GREENBRIER PKWY STE 100
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-3697
Practice Address - Country:US
Practice Address - Phone:757-410-7390
Practice Address - Fax:757-410-7395
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-16
Last Update Date:2016-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101048262207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1033129218Medicaid
VA1033129218Medicaid
VA160001318Medicare PIN