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General NPI Number Information
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NPI Number | 1992568588
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Entity Type | Individual
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Provider Name | ANDREW LUTZ
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Gender | Male
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Dates
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Enumeration Date | 02/05/2024
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Last Update Date | 02/05/2024
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Provider Practice Location Address
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Address Line | 8260 ATLEE RD
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City | MECHANICSVILLE
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State | VA
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Zip | 23116-1844
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Country | US
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Telephone | 804-764-6000
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Fax |
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Provider Business Mailing Address
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Address Line | 5412 MACALPINE CIR APT 1336
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City | GLEN ALLEN
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State | VA
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Zip | 23059-5574
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Country | US
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Telephone | 651-332-4638
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Fax |
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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 | 246ZC0007X
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Taxonomy Name | Surgical Assistant
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License Number | 0136000800
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License Number State | VA
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