Provider Demographics
NPI:1053316273
Name:KUTZERA, WILLIAM EUGENE (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:EUGENE
Last Name:KUTZERA
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 1:13424 PENNSYLVANIA AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21742
Mailing Address - Country:US
Mailing Address - Phone:301-791-7900
Mailing Address - Fax:301-791-3686
Practice Address - Street 1:13424 PENNSYLVANIA AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21742
Practice Address - Country:US
Practice Address - Phone:301-791-7900
Practice Address - Fax:301-791-3686
Is Sole Proprietor?:No
Enumeration Date:2005-06-15
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0046940207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD928801500Medicaid
MD928801500Medicaid
MDH06518Medicare UPIN