MEDICARE: DR. RITA DELORES WUTOH MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	D0053915	MD

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00381804	OTHER	MD	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	101895	OTHER	MD	JHHC PROVIDER NUMBER
4	1167557	OTHER	MD	CIGNA PIN
5	8163607	OTHER	MD	MAMSI PRIMARY CARE
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	2163607	OTHER	MD	MAMSI SPECIALIST
8	P17049	OTHER	MD	CAREFIRST MPOS
9	3654331	OTHER	MD	AETNA CAPITATED
10	5317701	OTHER	MD	AETNA FEE FOR SERVICE
11	7605-0081	OTHER	MD	CAREFIRST BLUECHOICE
12	642957-03	OTHER	MD	CAREFIRST MD RENDERING

General Provider Information

NPI Number	:	1841283835
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RITA DELORES WUTOH MD

Provider Business Mailing Address
First Line	:	7800 CENTRAL AVE
Second Line	:
City	:	HYATTSVILLE
State	:	MD
Zip	:	20785-4807
Country	:	US
Telephone Number	:	410-804-7200
Fax Number	:	301-218-7916

Provider Business Practice Location Address
First Line	:	7800 CENTRAL AVE
Second Line	:
City	:	HYATTSVILLE
State	:	MD
Zip	:	20785-4807
Country	:	US
Telephone Number	:	410-804-7200
Fax Number	:	301-218-7916

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/25/2005
Last Update Date	:	12/28/2020

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