1164434452 NPI number — CYNTHIA KUTTNER M.D.

Table of content: CYNTHIA KUTTNER M.D. (NPI 1164434452)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164434452 NPI number — CYNTHIA KUTTNER M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KUTTNER
Provider First Name:
CYNTHIA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KUTTNER-SANDS
Provider Other First Name:
CYNTHIA
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1164434452
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/16/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
142 PARKS HALL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ATHENS
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45701
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
740-593-2482
Provider Business Mailing Address Fax Number:
740-593-0036

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
142 PARKS HALL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ATHENS
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45701
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-593-2482
Provider Business Practice Location Address Fax Number:
740-593-0036
Provider Enumeration Date:
08/13/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RG0300X , with the licence number:  D47451 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RG0300X , with the licence number: 35098575 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 119C . This is a "BLUE SHIELD LOCAL" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 53543405 . This is a "BLUE SHIELD REGIONAL" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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