Healthcare Provider Details

I. General information

NPI: 1538107099
Provider Name (Legal Business Name): LINDA LOUISE LUTZ M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LINDA LUTZ-NAGEY M.D.

II. Dates (important events)

Enumeration Date: 06/04/2006
Last Update Date: 07/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

419 W REDWOOD ST SUITE 160
BALTIMORE MD
21201-1734
US

IV. Provider business mailing address

PO BOX 64445
BALTIMORE MD
21264-4445
US

V. Phone/Fax

Practice location:
  • Phone: 410-328-3167
  • Fax: 410-328-1323
Mailing address:
  • Phone: 410-328-5767
  • Fax: 410-328-0098

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberD26019
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: