Provider Demographics
NPI:1558313098
Name:KUTOK, JEFFERY LORNE (MD PHD)
Entity Type:Individual
Prefix:
First Name:JEFFERY
Middle Name:LORNE
Last Name:KUTOK
Suffix:
Gender:M
Credentials:MD PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 FRANCIS STREET AMORY 3
Mailing Address - Street 2:BRIGHAM AND WOMENS HOSPITAL DEPARTMENT OF PATHOLOGY
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02115
Mailing Address - Country:US
Mailing Address - Phone:617-732-5714
Mailing Address - Fax:
Practice Address - Street 1:75 FRANCIS STREET AMORY 3
Practice Address - Street 2:BRIGHAM AND WOMENS HOSPITAL DEPARTMENT OF PATHOLOGY
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115
Practice Address - Country:US
Practice Address - Phone:617-732-5714
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA160336207ZP0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology