Provider Demographics
NPI:1629073549
Name:KREUTZ, BERNY J (MD)
Entity Type:Individual
Prefix:
First Name:BERNY
Middle Name:J
Last Name:KREUTZ
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:PO BOX 791372
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21279
Mailing Address - Country:US
Mailing Address - Phone:301-608-8375
Mailing Address - Fax:301-608-3979
Practice Address - Street 1:6420 ROCKLEDGE DR
Practice Address - Street 2:2200
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20817-7837
Practice Address - Country:US
Practice Address - Phone:301-896-6880
Practice Address - Fax:301-896-6868
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2012-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0012566208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
30056OtherMDIPA
MD415096100Medicaid
5062BJOtherBC/BS
MD212221900Medicaid
B94695Medicare UPIN
G00134Medicare PIN
MD212221900Medicaid