Provider Demographics
NPI:1437319894
Name:UTZINGER, MALYNN LEE (MA,MD)
Entity Type:Individual
Prefix:
First Name:MALYNN
Middle Name:LEE
Last Name:UTZINGER
Suffix:
Gender:F
Credentials:MA,MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:174 WEST ST STE 114
Mailing Address - Street 2:
Mailing Address - City:LITCHFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06759-3434
Mailing Address - Country:US
Mailing Address - Phone:860-567-5664
Mailing Address - Fax:860-567-5914
Practice Address - Street 1:174 WEST ST STE 114
Practice Address - Street 2:
Practice Address - City:LITCHFIELD
Practice Address - State:CT
Practice Address - Zip Code:06759-3434
Practice Address - Country:US
Practice Address - Phone:860-567-5664
Practice Address - Fax:860-567-5914
Is Sole Proprietor?:No
Enumeration Date:2008-06-10
Last Update Date:2008-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT046605208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice