Provider Demographics
NPI:1679060370
Name:RUTKOFSKY, IAN HUNTER (MD)
Entity type:Individual
Prefix:DR
First Name:IAN
Middle Name:HUNTER
Last Name:RUTKOFSKY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10701 PARKRIDGE BLVD STE 110
Mailing Address - Street 2:
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20191-4423
Mailing Address - Country:US
Mailing Address - Phone:703-880-4000
Mailing Address - Fax:703-860-5760
Practice Address - Street 1:10701 PARKRIDGE BLVD STE 110
Practice Address - Street 2:
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20191-4423
Practice Address - Country:US
Practice Address - Phone:703-880-4000
Practice Address - Fax:703-860-5760
Is Sole Proprietor?:No
Enumeration Date:2018-04-18
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1494602084P0800X
MDD00942972084P0800X
OH35.1462872084P0800X
DEC1-00254842084P0800X
PAMD4795942084P0800X
NC2022-027262084P0800X
390200000X
VA01012752052084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program