Healthcare Provider Details

I. General information

NPI: 1093907982
Provider Name (Legal Business Name): AMY E MUTCH CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2007
Last Update Date: 12/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

711 MAIDEN CHOICE LN
CATONSVILLE MD
21228-3632
US

IV. Provider business mailing address

5525 RESEARCH PARK DR FL 4
BALTIMORE MD
21228-4873
US

V. Phone/Fax

Practice location:
  • Phone: 410-242-5602
  • Fax: 410-242-1756
Mailing address:
  • Phone: 410-247-5602
  • Fax: 410-242-1756

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License NumberR095947
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: