Provider Demographics
NPI:1326492315
Name:KUTZER, TATUM (DO)
Entity Type:Individual
Prefix:
First Name:TATUM
Middle Name:
Last Name:KUTZER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3864 ADLER PL STE 100
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18017-8101
Mailing Address - Country:US
Mailing Address - Phone:610-866-8331
Mailing Address - Fax:619-866-8408
Practice Address - Street 1:232 W 25TH ST # 3R
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16544-2306
Practice Address - Country:US
Practice Address - Phone:814-452-5530
Practice Address - Fax:814-452-5419
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-16
Last Update Date:2021-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
PAOS0208992084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program