Provider Demographics
NPI:1578708103
Name:CUTTIC, CHARLES E (PA-C)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:E
Last Name:CUTTIC
Suffix:
Gender:M
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 1:830 OLD LANCASTER AVENUE, SUITE 203
Mailing Address - Street 2:BRYN MAWR HOSPITAL
Mailing Address - City:BRYN MAWR
Mailing Address - State:PA
Mailing Address - Zip Code:19010
Mailing Address - Country:US
Mailing Address - Phone:610-527-1600
Mailing Address - Fax:610-527-0824
Practice Address - Street 1:830 OLD LANCASTER AVENUE, SUITE 203
Practice Address - Street 2:BRYN MAWR HOSPITAL
Practice Address - City:BRYN MAWR
Practice Address - State:PA
Practice Address - Zip Code:19010
Practice Address - Country:US
Practice Address - Phone:610-527-1600
Practice Address - Fax:610-527-0824
Is Sole Proprietor?:No
Enumeration Date:2008-12-11
Last Update Date:2008-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA000781L363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAMA000751LOtherLICENSE