Basic Information
| Provider Information | |||||||||
| NPI: | 1326030214 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RUTKOWSKI | ||||||||
| FirstName: | JANICE | ||||||||
| MiddleName: | F. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7580 BUCKINGHAM BLVD | ||||||||
| Address2: | SUITE 220 | ||||||||
| City: | HANOVER | ||||||||
| State: | MD | ||||||||
| PostalCode: | 210763002 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4107295100 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 7556 TEAGUE RD. | ||||||||
| Address2: | SUITE 210 | ||||||||
| City: | HANOVER | ||||||||
| State: | MD | ||||||||
| PostalCode: | 21076 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4105510499 | ||||||||
| FaxNumber: | 4107999070 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/17/2005 | ||||||||
| LastUpdateDate: | 04/11/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 04/11/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | D0027513 | MD | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 420210-10 | 01 | MD | CAREFIRST MD RENDERING | OTHER | 7605-0030 | 01 | MD | CAREFIRST BLUECHOICE | OTHER | 8163609 | 01 | MD | MAMSI PRIMARY CARE | OTHER | 0000611 | 01 | MD | AETNA CAPITATED | OTHER | 2163609 | 01 | MD | MAMSI SPECIALIST | OTHER | 586100400 | 05 | MD | MEDICAID | P12793 | 01 | MD | CAREFIRST MPOS | OTHER | 036584 | 01 | MD | JHHC PROVIDER NUMBER | OTHER | 110179667 | 01 | MD | RR MEDICARE | OTHER | 4137394 | 01 | MD | AETNA FEE FOR SERVICE | OTHER | 1402555 | 01 | MD | CIGNA PIN | OTHER |