Healthcare Provider Details

I. General information

NPI: 1831276112
Provider Name (Legal Business Name): TREVOR LEE KUTTLER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 08/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 JOHN PAUL JONES CIR LABORATORY
PORTSMOUTH VA
23708-2197
US

IV. Provider business mailing address

620 JOHN PAUL JONES CIR LABORATORY
PORTSMOUTH VA
23708-2197
US

V. Phone/Fax

Practice location:
  • Phone: 757-953-1689
  • Fax: 757-953-0818
Mailing address:
  • Phone: 757-953-1689
  • Fax: 757-953-0818

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number0101242172
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: