Provider Demographics
NPI:1225414154
Name:KUTSCHBACH, JOSHUA L (MS RDN LD)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:L
Last Name:KUTSCHBACH
Suffix:
Gender:M
Credentials:MS RDN LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:540 E BELVEDERE AVE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21212-3750
Mailing Address - Country:US
Mailing Address - Phone:567-208-8347
Mailing Address - Fax:
Practice Address - Street 1:540 E BELVEDERE AVE
Practice Address - Street 2:SUITE 203
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21212-3750
Practice Address - Country:US
Practice Address - Phone:567-208-8347
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-03
Last Update Date:2015-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDDX3786133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered