Provider Demographics
NPI:1811994452
Name:RUTTA, DAVID (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:RUTTA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:517 ASH ST
Mailing Address - Street 2:
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18509-2903
Mailing Address - Country:US
Mailing Address - Phone:570-969-6100
Mailing Address - Fax:570-983-0267
Practice Address - Street 1:517 ASH ST
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18509-2903
Practice Address - Country:US
Practice Address - Phone:570-969-6100
Practice Address - Fax:570-983-0267
Is Sole Proprietor?:No
Enumeration Date:2005-06-28
Last Update Date:2011-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD041071E207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001132514Medicaid
PA517288M0JMedicare ID - Type Unspecified
PA001132514Medicaid