Provider Demographics
NPI:1306811062
Name:RUTTER, CHAD M (DO)
Entity type:Individual
Prefix:DR
First Name:CHAD
Middle Name:M
Last Name:RUTTER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1861 POWDER MILL RD
Mailing Address - Street 2:ATTN MEDICAL STAFF OFFICE
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-4723
Mailing Address - Country:US
Mailing Address - Phone:717-718-2000
Mailing Address - Fax:717-741-9867
Practice Address - Street 1:1665 ROOSEVELT AVE
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17408-8549
Practice Address - Country:US
Practice Address - Phone:717-848-4800
Practice Address - Fax:717-741-9867
Is Sole Proprietor?:No
Enumeration Date:2006-02-17
Last Update Date:2022-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS009261L207XS0117X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PACK4276OtherMEDICARE RR PALMETO GBA
PA202459OtherHEALTH AMERICA
PA177124OtherHIGHMARK
PA03182100OtherCAPITAL BLUE CROSS
PAH32605Medicare UPIN
PA03182100OtherCAPITAL BLUE CROSS