MEDICARE: DR. STEPHEN 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	207Q00000X	Family Medicine Physician	MD14516	ME
2	207Q00000X	Family Medicine Physician	9321	NH

General Provider Information

NPI Number	:	1881640761
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEPHEN LUTZ MD

Provider Business Mailing Address
First Line	:	PO BOX 9746
Second Line	:
City	:	PORTLAND
State	:	ME
Zip	:	04104-5040
Country	:	US
Telephone Number	:	207-791-3888
Fax Number	:	207-828-7850

Provider Business Practice Location Address
First Line	:	161 CORPORATE DR
Second Line	:
City	:	PORTSMOUTH
State	:	NH
Zip	:	03801-6825
Country	:	US
Telephone Number	:	603-431-5154
Fax Number	:	603-430-5083

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

Provider Enumeration Date	:	05/25/2006
Last Update Date	:	10/01/2020

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