Basic Information
| Provider Information | |||||||||
| NPI: | 1508870882 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RUTMAN | ||||||||
| FirstName: | MAIA | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | ONE MEDICAL CENTER DRIVE | ||||||||
| Address2: | DARTMOUTH HITCHCOCK MED CTR DEPARTMENT OF PEDIATRICS | ||||||||
| City: | LEBANON | ||||||||
| State: | NH | ||||||||
| PostalCode: | 037560001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6036507254 | ||||||||
| FaxNumber: | 6036500473 | ||||||||
| Practice Location | |||||||||
| Address1: | ONE MEDICAL CENTER DR | ||||||||
| Address2: | DARTMOUTH HITCHCOCK MED CTR EMERGENCY DPTMT | ||||||||
| City: | LEBNON | ||||||||
| State: | NH | ||||||||
| PostalCode: | 037560001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6036507254 | ||||||||
| FaxNumber: | 6036500473 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/29/2006 | ||||||||
| LastUpdateDate: | 05/13/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | MD11521 | RI | N | Allopathic & Osteopathic Physicians | Pediatrics | 208000000X | 13562 | NH | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 7057260 | 05 | RI | MEDICAID |