MEDICARE: PATRICIA A LUTZ MD

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	208000000X	Pediatrics Physician	18650	WV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1558325571
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATRICIA A LUTZ MD

Provider Business Mailing Address
First Line	:	2915 3RD AVE STE 3500
Second Line	:
City	:	HUNTINGTON
State	:	WV
Zip	:	25702-1401
Country	:	US
Telephone Number	:	304-691-8900
Fax Number	:	304-525-6238

Provider Business Practice Location Address
First Line	:	2915 3RD AVE
Second Line	:
City	:	HUNTINGTON
State	:	WV
Zip	:	25702-1401
Country	:	US
Telephone Number	:	304-691-8900
Fax Number	:	304-525-6238

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

Provider Enumeration Date	:	04/14/2006
Last Update Date	:	12/28/2021

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