Provider Demographics
NPI:1538107099
Name:LUTZ, LINDA LOUISE (MD)
Entity Type:Individual
Prefix:DR
First Name:LINDA
Middle Name:LOUISE
Last Name:LUTZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LINDA
Other - Middle Name:
Other - Last Name:LUTZ-NAGEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 64445
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21264-4445
Mailing Address - Country:US
Mailing Address - Phone:410-328-5767
Mailing Address - Fax:410-328-0098
Practice Address - Street 1:419 W REDWOOD ST
Practice Address - Street 2:SUITE 160
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-1734
Practice Address - Country:US
Practice Address - Phone:410-328-3167
Practice Address - Fax:410-328-1323
Is Sole Proprietor?:No
Enumeration Date:2006-06-04
Last Update Date:2010-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD26019207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD793291000Medicaid
MD33122003OtherCAREFIRST OF MD
DCS045-0005OtherBLUE SHIELD FEDERAL
MD793291000Medicaid
MDB70940Medicare UPIN
070008587Medicare PIN