Provider Demographics
NPI:1841283835
Name:WUTOH, RITA DELORES (MD)
Entity type:Individual
Prefix:DR
First Name:RITA
Middle Name:DELORES
Last Name:WUTOH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:7800 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20785-4807
Mailing Address - Country:US
Mailing Address - Phone:410-804-7200
Mailing Address - Fax:301-218-7916
Practice Address - Street 1:7800 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20785-4807
Practice Address - Country:US
Practice Address - Phone:410-804-7200
Practice Address - Fax:301-218-7916
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-25
Last Update Date:2020-12-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD0053915207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD332502400Medicaid
MDP00381804OtherRAILROAD MEDICARE
MD101895OtherJHHC PROVIDER NUMBER
MD1167557OtherCIGNA PIN
MD8163607OtherMAMSI PRIMARY CARE
MD521923448Medicaid
MD2163607OtherMAMSI SPECIALIST
MDP17049OtherCAREFIRST MPOS
MD3654331OtherAETNA CAPITATED
MD5317701OtherAETNA FEE FOR SERVICE
MD7605-0081OtherCAREFIRST BLUECHOICE
MD642957-03OtherCAREFIRST MD RENDERING
MD7605-0081OtherCAREFIRST BLUECHOICE
G65020Medicare UPIN