Provider Demographics
NPI:1740990316
Name:CARRUTH, GINA THERESA
Entity type:Individual
Prefix:MRS
First Name:GINA
Middle Name:THERESA
Last Name:CARRUTH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5128 SEVEN OAKS DR
Mailing Address - Street 2:
Mailing Address - City:CLIFTON HTS
Mailing Address - State:PA
Mailing Address - Zip Code:19018-1016
Mailing Address - Country:US
Mailing Address - Phone:610-812-0099
Mailing Address - Fax:
Practice Address - Street 1:5128 SEVEN OAKS DR
Practice Address - Street 2:
Practice Address - City:CLIFTON HTS
Practice Address - State:PA
Practice Address - Zip Code:19018-1016
Practice Address - Country:US
Practice Address - Phone:610-812-0099
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-05
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor