Healthcare Provider Details

I. General information

NPI: 1306811062
Provider Name (Legal Business Name): CHAD M RUTTER D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/17/2006
Last Update Date: 03/30/2022
Certification Date: 03/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1665 ROOSEVELT AVE
YORK PA
17408-8549
US

IV. Provider business mailing address

1861 POWDER MILL RD ATTN MEDICAL STAFF OFFICE
YORK PA
17402-4723
US

V. Phone/Fax

Practice location:
  • Phone: 717-848-4800
  • Fax: 717-741-9867
Mailing address:
  • Phone: 717-718-2000
  • Fax: 717-741-9867

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License NumberOS009261L
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberOS009261L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: