Healthcare Provider Details

I. General information

NPI: 1164434452
Provider Name (Legal Business Name): CYNTHIA KUTTNER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CYNTHIA KUTTNER-SANDS M.D.

II. Dates (important events)

Enumeration Date: 08/13/2006
Last Update Date: 12/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

142 PARKS HALL
ATHENS OH
45701
US

IV. Provider business mailing address

142 PARKS HALL
ATHENS OH
45701
US

V. Phone/Fax

Practice location:
  • Phone: 740-593-2482
  • Fax: 740-593-0036
Mailing address:
  • Phone: 740-593-2482
  • Fax: 740-593-0036

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License NumberD47451
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number35098575
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: