Provider Demographics
NPI:1356760094
Name:MCCUTCHEON, JUSTIN MITCHEL (MD)
Entity type:Individual
Prefix:
First Name:JUSTIN
Middle Name:MITCHEL
Last Name:MCCUTCHEON
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 1:21 THIRTY ACRES
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:OH
Mailing Address - Zip Code:44236-3327
Mailing Address - Country:US
Mailing Address - Phone:330-819-4505
Mailing Address - Fax:513-245-3672
Practice Address - Street 1:444 N MAIN ST
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44310-3110
Practice Address - Country:US
Practice Address - Phone:330-819-4505
Practice Address - Fax:513-558-0877
Is Sole Proprietor?:No
Enumeration Date:2014-04-09
Last Update Date:2020-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.1330232084P0800X
OH390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program