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General NPI Number Information
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NPI Number | 1972544989
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Entity Type | Individual
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Provider Name | JUSTIN A MUTCH MD
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Gender | Male
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Dates
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Enumeration Date | 06/09/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1212 MCCONVILLE ROAD
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City | LYNCHBURG
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State | VA
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Zip | 24502
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Country | US
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Telephone | 434-237-8886
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Fax | 434-239-6807
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Provider Business Mailing Address
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Address Line | 1212 MCCONVILLE ROAD
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City | LYNCHBURG
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State | VA
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Zip | 24502
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Country | US
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Telephone | 434-237-8886
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Fax | 434-239-6807
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 0101234547
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License Number State | VA
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