Provider Demographics
NPI:1417524679
Name:KUTZERA, MADISON GRACE (PA-C)
Entity Type:Individual
Prefix:
First Name:MADISON
Middle Name:GRACE
Last Name:KUTZERA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9256 BENDIX RD STE 200B
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21045-1848
Mailing Address - Country:US
Mailing Address - Phone:443-542-0773
Mailing Address - Fax:
Practice Address - Street 1:9256 BENDIX RD STE 200B
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045-1848
Practice Address - Country:US
Practice Address - Phone:443-542-0773
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-07
Last Update Date:2022-02-23
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant