Organization
DANIEL RUTRICK, MD, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DANIEL RUTRICK M.D. (PRESIDENT)
(617) 387-2220
Entity
Organization
Contact information
Practice address
617 BROADWAY, EVERETT, MA 02149-3712
(617) 387-2220
(617) 394-0538
Mailing address
617 BROADWAY, EVERETT, MA 02149-3712
(617) 387-2220
(617) 394-0538
Taxonomy
Speciality
Code
Description
License number
State
103TP0016X
Prescribing (Medical) Psychologist
Primary
36462
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
036462
TUFTS GROUP NUMBER
MA
01
—
500019
TUFTS PSYCHOLOGIST NUMBER
MA
01
—
500064
TUFTS CERTIFIED NURSE
MA
01
—
M13835
BLUE CROSS BLUE SHIELD
MA
Enumeration date
06/01/2007
Last updated
08/22/2020
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