Provider Demographics
NPI:1881859106
Name:JOHNYKUTTY, RENE (MD)
Entity Type:Individual
Prefix:DR
First Name:RENE
Middle Name:
Last Name:JOHNYKUTTY
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 1:150 KIMBERTON CT
Mailing Address - Street 2:UNIT B4
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19901-4276
Mailing Address - Country:US
Mailing Address - Phone:585-698-8640
Mailing Address - Fax:
Practice Address - Street 1:4735 OGLETOWN STANTON RD
Practice Address - Street 2:MAP 2, SUITE 2112
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713-2072
Practice Address - Country:US
Practice Address - Phone:302-623-2853
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-25
Last Update Date:2015-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC10009754207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine