Provider Demographics
NPI:1538184528
Name:RUTHERFORD, MARY CATHERINE (MD)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:CATHERINE
Last Name:RUTHERFORD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1023 NEW MOODY LN
Mailing Address - Street 2:SUITE 201
Mailing Address - City:LA GRANGE
Mailing Address - State:KY
Mailing Address - Zip Code:40031-9177
Mailing Address - Country:US
Mailing Address - Phone:502-225-4480
Mailing Address - Fax:502-225-9169
Practice Address - Street 1:1023 NEW MOODY LN
Practice Address - Street 2:SUITE 201
Practice Address - City:LA GRANGE
Practice Address - State:KY
Practice Address - Zip Code:40031-9177
Practice Address - Country:US
Practice Address - Phone:502-225-4480
Practice Address - Fax:502-225-9169
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2012-12-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY40265207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64120769Medicaid
KY000000740355OtherANTHEM
KY64120769Medicaid