Healthcare Provider Details

I. General information

NPI: 1932128246
Provider Name (Legal Business Name): PAMELA HELLERMAN RUTKOSKI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 05/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

990 THOMPSON ST
JERSEY SHORE PA
17740-1727
US

IV. Provider business mailing address

PO BOX 430
AVIS PA
17721-0430
US

V. Phone/Fax

Practice location:
  • Phone: 570-398-2600
  • Fax: 570-398-2055
Mailing address:
  • Phone: 570-398-5195
  • Fax: 570-873-3177

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD034656E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: