Provider Demographics
NPI:1073878872
Name:KRUTZLER-BERRY, DIANE MARIE (MD)
Entity Type:Individual
Prefix:DR
First Name:DIANE
Middle Name:MARIE
Last Name:KRUTZLER-BERRY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 HAL GREER BLVD
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25701-4114
Mailing Address - Country:US
Mailing Address - Phone:304-399-6610
Mailing Address - Fax:304-399-6621
Practice Address - Street 1:1400 HAL GREER BLVD
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25701-4114
Practice Address - Country:US
Practice Address - Phone:304-399-6610
Practice Address - Fax:304-399-6621
Is Sole Proprietor?:No
Enumeration Date:2012-07-08
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL00000208600000X, 208600000X
WV30719208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery