Provider Demographics
NPI:1053482836
Name:NUTTER, JAMES WILLARD (EDD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:WILLARD
Last Name:NUTTER
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 987
Mailing Address - Street 2:
Mailing Address - City:ST MARYS CITY
Mailing Address - State:MD
Mailing Address - Zip Code:20686-0987
Mailing Address - Country:US
Mailing Address - Phone:301-862-9551
Mailing Address - Fax:301-862-9551
Practice Address - Street 1:47161 S SNOWHILL MANOR ROAD
Practice Address - Street 2:
Practice Address - City:LEXINGTON PARK
Practice Address - State:MD
Practice Address - Zip Code:20653
Practice Address - Country:US
Practice Address - Phone:301-862-9551
Practice Address - Fax:301-862-9551
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD02851103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
R05562Medicare UPIN
MD066SMedicare ID - Type Unspecified