Provider Demographics
NPI:1912051038
Name:FRUTH, JOANNE (MD)
Entity Type:Individual
Prefix:
First Name:JOANNE
Middle Name:
Last Name:FRUTH
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 1:815 OBERLIN RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27605-1300
Mailing Address - Country:US
Mailing Address - Phone:919-322-4722
Mailing Address - Fax:919-322-4729
Practice Address - Street 1:815 OBERLIN RD
Practice Address - Street 2:SUITE 200
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27605-1300
Practice Address - Country:US
Practice Address - Phone:919-322-4722
Practice Address - Fax:919-322-4729
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2016-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC94-00800207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2201650AMedicare ID - Type Unspecified
F85576Medicare ID - Type Unspecified
NC8984359Medicare ID - Type Unspecified