Provider Demographics
NPI:1780614651
Name:CUTTINO, LAURIE W (MD)
Entity type:Individual
Prefix:DR
First Name:LAURIE
Middle Name:W
Last Name:CUTTINO
Suffix:
Gender:F
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:PO BOX 91734
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23291-1734
Mailing Address - Country:US
Mailing Address - Phone:804-358-6100
Mailing Address - Fax:804-342-7619
Practice Address - Street 1:1250 E MARSHALL STREET
Practice Address - Street 2:RADIATION ONCOLOGY
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23298-0058
Practice Address - Country:US
Practice Address - Phone:804-828-7232
Practice Address - Fax:804-828-6042
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01012333552085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAP00479175OtherRAILROAD MEDICARE
VA010383684Medicaid
VA010292123Medicaid
VA83-0454770OtherEIN
VAP00418301Medicare PIN
VA83-0454770OtherEIN
VA010595M41Medicare PIN
VA010383684Medicare PIN
VAP00479175OtherRAILROAD MEDICARE
VAC03684Medicare PIN