Healthcare Provider Details

I. General information

NPI: 1952898637
Provider Name (Legal Business Name): MELISSA RACHEL LUTZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MELISSA RACHEL LANGER MD

II. Dates (important events)

Enumeration Date: 04/18/2018
Last Update Date: 07/09/2024
Certification Date: 07/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 S GREENE ST # S6ABC
BALTIMORE MD
21201-1544
US

IV. Provider business mailing address

PO BOX 62063
BALTIMORE MD
21264-2063
US

V. Phone/Fax

Practice location:
  • Phone: 410-706-5181
  • Fax: 410-225-8766
Mailing address:
  • Phone: 410-706-5181
  • Fax: 410-706-5103

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberD0091801
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: