Provider Demographics
NPI:1053920579
Name:RUTH, CHRISTIAN JOHN (PA-C)
Entity type:Individual
Prefix:MR
First Name:CHRISTIAN
Middle Name:JOHN
Last Name:RUTH
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 ROUTE 73 N STE 320
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-3426
Mailing Address - Country:US
Mailing Address - Phone:856-872-7055
Mailing Address - Fax:
Practice Address - Street 1:3920 DUPONT PKWY STE A
Practice Address - Street 2:
Practice Address - City:TOWNSEND
Practice Address - State:DE
Practice Address - Zip Code:19734-9000
Practice Address - Country:US
Practice Address - Phone:302-449-2570
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-30
Last Update Date:2024-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC5-0011435363A00000X
363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant