Provider Demographics
NPI:1417903188
Name:LUTZ, ROLAND BRUCE (MD)
Entity Type:Individual
Prefix:DR
First Name:ROLAND
Middle Name:BRUCE
Last Name:LUTZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 MEDICAL CENTER BLVD
Mailing Address - Street 2:CCMC POBII STE 324
Mailing Address - City:UPLAND
Mailing Address - State:PA
Mailing Address - Zip Code:19013-3902
Mailing Address - Country:US
Mailing Address - Phone:610-876-0347
Mailing Address - Fax:610-876-3788
Practice Address - Street 1:1 MEDICAL CENTER BLVD
Practice Address - Street 2:CCMC POBII STE 324
Practice Address - City:UPLAND
Practice Address - State:PA
Practice Address - Zip Code:19013-3902
Practice Address - Country:US
Practice Address - Phone:610-876-0347
Practice Address - Fax:610-876-3788
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD030725E207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1282594Medicaid
PA1282594Medicaid
PALU728258Medicare ID - Type Unspecified