Healthcare Provider Details

I. General information

NPI: 1093385106
Provider Name (Legal Business Name): FABIAN LUDWIG KUTTNER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2021
Last Update Date: 06/11/2024
Certification Date: 06/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 PRESTON AVE STE 400
CHARLOTTESVILLE VA
22903-4491
US

IV. Provider business mailing address

408 E MARKET ST APT 308
CHARLOTTESVILLE VA
22902-5258
US

V. Phone/Fax

Practice location:
  • Phone: 434-249-7661
  • Fax:
Mailing address:
  • Phone: 434-249-7661
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number0704007750
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: