Healthcare Provider Details

I. General information

NPI: 1073878872
Provider Name (Legal Business Name): DIANE MARIE KRUTZLER-BERRY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2012
Last Update Date: 03/11/2024
Certification Date: 03/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 HAL GREER BLVD
HUNTINGTON WV
25701-4114
US

IV. Provider business mailing address

1400 HAL GREER BLVD
HUNTINGTON WV
25701-4114
US

V. Phone/Fax

Practice location:
  • Phone: 304-399-6610
  • Fax: 304-399-6621
Mailing address:
  • Phone: 304-399-6610
  • Fax: 304-399-6621

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number00000
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number30719
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: