Provider Demographics
NPI:1629152590
Name:TUTTLE, JANET ELIZABETH (MD)
Entity type:Individual
Prefix:
First Name:JANET
Middle Name:ELIZABETH
Last Name:TUTTLE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JANET
Other - Middle Name:ELIZABETH
Other - Last Name:TUTTLE-NEWHALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:900 ELKRIDGE LANDING RD FL 2
Mailing Address - Street 2:
Mailing Address - City:LINTHICUM
Mailing Address - State:MD
Mailing Address - Zip Code:21090-2924
Mailing Address - Country:US
Mailing Address - Phone:443-496-3443
Mailing Address - Fax:
Practice Address - Street 1:901 HARRY S TRUMAN DR N
Practice Address - Street 2:
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20774-5477
Practice Address - Country:US
Practice Address - Phone:240-677-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2024-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD966972086S0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1045XOtherBCBS NC
NC1629152590Medicaid
NCNCO1750322Medicare PIN