Provider Demographics
NPI:1033165196
Name:CUTLER, CHARLES (MD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:
Last Name:CUTLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 FEDERAL ST # 200
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08103-1088
Mailing Address - Country:US
Mailing Address - Phone:856-356-4924
Mailing Address - Fax:
Practice Address - Street 1:559 W GERMANTOWN PIKE
Practice Address - Street 2:
Practice Address - City:EAST NORRITON
Practice Address - State:PA
Practice Address - Zip Code:19403-4250
Practice Address - Country:US
Practice Address - Phone:610-279-8300
Practice Address - Fax:610-279-5965
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2023-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD016965E207R00000X
NJ25MA11233600207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0045722000OtherIBC - PC/KHPE
PA0019255OtherAETNA HMO
PA30010610OtherKEYSTONE MERCY
PA68800OtherFIRST HEALTH
PA0006267070004Medicaid
PA025666OtherHIGHMARK BLUE SHIELD
PA1235185OtherCIGNA HMO/PPO
PAP00064588OtherRRM
PA0045722000OtherAMERIHEALTH/INTERCOUNTY
PA113664OtherPHCS
PA4100033OtherAETNA PPO
PA10925258OtherCAQH ID #
PA025666SBHMedicare ID - Type UnspecifiedHGSA
PA0006267070004Medicaid