MEDICARE: DR. DAVID P. HUTZ M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	MD422703	PA

General Provider Information

NPI Number	:	1205895083
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID P. HUTZ M.D.

Provider Business Mailing Address
First Line	:	100 N ACADEMY AVE
Second Line	:
City	:	DANVILLE
State	:	PA
Zip	:	17822-3034
Country	:	US
Telephone Number	:	570-271-6144
Fax Number	:	570-271-6578

Provider Business Practice Location Address
First Line	:	40 DALLAS SHOPPING CTR
Second Line	:
City	:	DALLAS
State	:	PA
Zip	:	18612-1231
Country	:	US
Telephone Number	:	570-675-2000
Fax Number	:	570-675-1806

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/21/2006
Last Update Date	:	07/08/2007

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