Provider Demographics
NPI:1487710083
Name:STRUTT, GEORGE FRANKLIN (PHD)
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:FRANKLIN
Last Name:STRUTT
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5024 CAMPBELL BLVD
Mailing Address - Street 2:SUITE H
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21236-5974
Mailing Address - Country:US
Mailing Address - Phone:410-931-9280
Mailing Address - Fax:410-931-6694
Practice Address - Street 1:5024 CAMPBELL BLVD
Practice Address - Street 2:SUITE H
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21236-5974
Practice Address - Country:US
Practice Address - Phone:410-931-9280
Practice Address - Fax:410-931-6694
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2008-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01913103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD299L623BMedicare ID - Type Unspecified