Healthcare Provider Details

I. General information

NPI: 1154749299
Provider Name (Legal Business Name): CHLOE RUGUT M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2014
Last Update Date: 10/07/2024
Certification Date: 10/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 HADDON AVE FL 3
CAMDEN NJ
08103-3101
US

IV. Provider business mailing address

301 LIPPINCOTT DR STE 410
MARLTON NJ
08053-4197
US

V. Phone/Fax

Practice location:
  • Phone: 856-757-3500
  • Fax:
Mailing address:
  • Phone: 856-355-0340
  • Fax: 856-355-0330

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number25MA10354400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: