Provider Demographics
NPI:1881665438
Name:UTZURRUM, EUGENIA B (MD)
Entity Type:Individual
Prefix:
First Name:EUGENIA
Middle Name:B
Last Name:UTZURRUM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:10600 YORK RD, STE 103
Mailing Address - Street 2:YORK RIDGE CENTER NORTH
Mailing Address - City:COCKEYSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21030
Mailing Address - Country:US
Mailing Address - Phone:410-252-7500
Mailing Address - Fax:410-252-3636
Practice Address - Street 1:57 W TIMONIUM RD
Practice Address - Street 2:SUITE 102
Practice Address - City:LUTHERVILLE
Practice Address - State:MD
Practice Address - Zip Code:21093-3125
Practice Address - Country:US
Practice Address - Phone:410-252-7500
Practice Address - Fax:410-252-3636
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-31
Last Update Date:2014-09-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MDD00162562080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD419501900Medicaid
MD419501900Medicaid