Provider Demographics
NPI:1215250345
Name:JOHN A. RUTH, JR., M.D., P.A.
Entity type:Organization
Organization Name:JOHN A. RUTH, JR., M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:A
Authorized Official - Last Name:RUTH
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD, PA
Authorized Official - Phone:410-366-5775
Mailing Address - Street 1:3333 N CALVERT ST
Mailing Address - Street 2:SUITE 530
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21218-2867
Mailing Address - Country:US
Mailing Address - Phone:410-366-5775
Mailing Address - Fax:
Practice Address - Street 1:125 AIRPORT DR
Practice Address - Street 2:SUITE 34
Practice Address - City:WESTMINSTER
Practice Address - State:MD
Practice Address - Zip Code:21157-3024
Practice Address - Country:US
Practice Address - Phone:410-840-3336
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-03
Last Update Date:2010-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD38499207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD530911500Medicaid
MD530911500Medicaid