Healthcare Provider Details

I. General information

NPI: 1053316273
Provider Name (Legal Business Name): WILLIAM EUGENE KUTZERA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2005
Last Update Date: 05/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13424 PENNSYLVANIA AVE SUITE 101
HAGERSTOWN MD
21742
US

IV. Provider business mailing address

13424 PENNSYLVANIA AVE SUITE 101
HAGERSTOWN MD
21742
US

V. Phone/Fax

Practice location:
  • Phone: 301-791-7900
  • Fax: 301-791-3686
Mailing address:
  • Phone: 301-791-7900
  • Fax: 301-791-3686

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberD0046940
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: