Healthcare Provider Details

I. General information

NPI: 1144201666
Provider Name (Legal Business Name): MAURICE W STUTZMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/10/2005
Last Update Date: 12/05/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4907A DALBEY LANE
BERLIN OH
44610
US

IV. Provider business mailing address

PO BOX 366 4907A DALBEY LANE
BERLIN OH
44610-0366
US

V. Phone/Fax

Practice location:
  • Phone: 330-893-2341
  • Fax: 330-893-3027
Mailing address:
  • Phone: 330-893-2341
  • Fax: 330-893-3027

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35048434
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: