Healthcare Provider Details

I. General information

NPI: 1215132337
Provider Name (Legal Business Name): SAMANTHA GREY CUTLER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SAMANTHA JOY GREY

II. Dates (important events)

Enumeration Date: 06/19/2007
Last Update Date: 08/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13001 SUMMIT SCHOOL RD
WOODBRIDGE VA
22192-2903
US

IV. Provider business mailing address

7015C MANCHESTER BLVD
ALEXANDRIA VA
22310-3253
US

V. Phone/Fax

Practice location:
  • Phone: 703-494-4811
  • Fax: 703-494-2098
Mailing address:
  • Phone: 703-971-6900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0101241587
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: