Provider Demographics
NPI:1306845995
Name:LUTZ, CHARLES K (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:K
Last Name:LUTZ
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:985 BERKSHIRE BLVD
Mailing Address - Street 2:STE 101
Mailing Address - City:WYOMISSING
Mailing Address - State:PA
Mailing Address - Zip Code:19610-1268
Mailing Address - Country:US
Mailing Address - Phone:610-374-5599
Mailing Address - Fax:610-288-8075
Practice Address - Street 1:985 BERKSHIRE BLVD
Practice Address - Street 2:STE 101
Practice Address - City:WYOMISSING
Practice Address - State:PA
Practice Address - Zip Code:19610-1268
Practice Address - Country:US
Practice Address - Phone:610-374-5599
Practice Address - Fax:610-288-8075
Is Sole Proprietor?:No
Enumeration Date:2005-07-18
Last Update Date:2021-01-20
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Provider Licenses
StateLicense IDTaxonomies
PAMD035112E207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA178694OtherHIGHMARK BLUE SHIELD
PA30717COtherAMERIHEALTH MERCY
PA0178694OtherKEYSTONE HP CENTRAL
PA0901012001OtherCIGNA
PA0011631270003Medicaid
PA01695001OtherCAPITAL BLUE CROSS
PA0278639000OtherINDEPENDENCE BLUE CROSS
PA57329OtherAETNA
PA0278639000OtherINDEPENDENCE BLUE CROSS
PAE12969Medicare UPIN