Healthcare Provider Details

I. General information

NPI: 1063584795
Provider Name (Legal Business Name): CHARLES GEORGE LEUTZINGER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 ELLIOT WAY
MANCHESTER NH
03103-3502
US

IV. Provider business mailing address

291 MOODY ST
LUDLOW MA
01056-1246
US

V. Phone/Fax

Practice location:
  • Phone: 603-663-2361
  • Fax: 603-668-4303
Mailing address:
  • Phone: 800-866-6663
  • Fax: 888-413-1065

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number6390
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: