Healthcare Provider Details

I. General information

NPI: 1972502789
Provider Name (Legal Business Name): CATHERINE LARUFFA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2005
Last Update Date: 10/07/2019
Certification Date:
Deactivation Date: 03/17/2006
Reactivation Date: 03/28/2006

III. Provider practice location address

700 S BROADWAY ST
BLANCHESTER OH
45107-1465
US

IV. Provider business mailing address

700 S BROADWAY ST
BLANCHESTER OH
45107-1465
US

V. Phone/Fax

Practice location:
  • Phone: 937-783-2600
  • Fax: 937-783-3086
Mailing address:
  • Phone: 937-783-2600
  • Fax: 937-783-3086

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35-061245
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: