Healthcare Provider Details

I. General information

NPI: 1053920579
Provider Name (Legal Business Name): CHRISTIAN JOHN RUTH PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2020
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 TOWNE CENTRE DR STE 500
DOVER DE
19904-4062
US

IV. Provider business mailing address

PO BOX 191
ROCKLAND DE
19732-0191
US

V. Phone/Fax

Practice location:
  • Phone: 302-672-5650
  • Fax:
Mailing address:
  • Phone: 302-651-6212
  • Fax: 302-651-4945

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberC5-0011435
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: