Healthcare Provider Details

I. General information

NPI: 1629073549
Provider Name (Legal Business Name): BERNY J KREUTZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2005
Last Update Date: 12/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6420 ROCKLEDGE DR 2200
BETHESDA MD
20817-7837
US

IV. Provider business mailing address

PO BOX 791372
BALTIMORE MD
21279
US

V. Phone/Fax

Practice location:
  • Phone: 301-896-6880
  • Fax: 301-896-6868
Mailing address:
  • Phone: 301-608-8375
  • Fax: 301-608-3979

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberD0012566
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: