Healthcare Provider Details

I. General information

NPI: 1619961554
Provider Name (Legal Business Name): DOUGLAS P CUTILLO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/07/2005
Last Update Date: 08/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 QUINCY AVE
SCRANTON PA
18510-1724
US

IV. Provider business mailing address

PO BOX 49
PITTSBURGH PA
15230-0049
US

V. Phone/Fax

Practice location:
  • Phone: 570-307-4225
  • Fax: 570-307-4226
Mailing address:
  • Phone: 412-937-5726
  • Fax: 412-937-5706

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License NumberMD049804L
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberMD049804L
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: