Provider Demographics
NPI:1720150287
Name:DURRUTHY, STEPHANIE SUSAN (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:SUSAN
Last Name:DURRUTHY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5074 DORSEY HALL DR
Mailing Address - Street 2:SUITE 105
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21042-7792
Mailing Address - Country:US
Mailing Address - Phone:410-992-0272
Mailing Address - Fax:410-964-0048
Practice Address - Street 1:5074 DORSEY HALL DR
Practice Address - Street 2:SUITE 105
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21042-7792
Practice Address - Country:US
Practice Address - Phone:410-992-0272
Practice Address - Fax:410-964-0048
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00364432084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDE52420Medicare UPIN