Healthcare Provider Details

I. General information

NPI: 1194940601
Provider Name (Legal Business Name): SINAN KUTTY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2007
Last Update Date: 02/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 OSTRUM ST SUITE 601
FOUNTAIN HILL PA
18015-1155
US

IV. Provider business mailing address

701 OSTRUM ST SUITE 601
FOUNTAIN HILL PA
18015-1155
US

V. Phone/Fax

Practice location:
  • Phone: 484-526-6545
  • Fax: 484-526-6546
Mailing address:
  • Phone: 484-526-6545
  • Fax: 484-526-6546

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number25MA08892000
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberMD453096
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: