Provider Demographics
NPI:1720074230
Name:CUTLER, CARLO JOHN (DO)
Entity Type:Individual
Prefix:
First Name:CARLO
Middle Name:JOHN
Last Name:CUTLER
Suffix:
Gender:M
Credentials:DO
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 1248
Mailing Address - Street 2:
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21741-1248
Mailing Address - Country:US
Mailing Address - Phone:800-938-2828
Mailing Address - Fax:302-733-0854
Practice Address - Street 1:1701 INNOVATION DR
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17408-8815
Practice Address - Country:US
Practice Address - Phone:800-436-4326
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-21
Last Update Date:2020-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDH0062337207L00000X
PAOS020103207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD408152800Medicaid
WV3810002654Medicaid
MDP00251804OtherRAILROAD MEDICARE
MD408152800Medicaid