Healthcare Provider Details

I. General information

NPI: 1669670618
Provider Name (Legal Business Name): JOHN C HUETSCH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2007
Last Update Date: 08/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5501 HOPKINS BAYVIEW CIR FL 4
BALTIMORE MD
21224-6821
US

IV. Provider business mailing address

9910 FRANKLIN SQUARE DR STE 2110
BALTIMORE MD
21236-4902
US

V. Phone/Fax

Practice location:
  • Phone: 410-550-2304
  • Fax: 410-550-8050
Mailing address:
  • Phone: 410-933-6423
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberD75796
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number2010012750
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: