Provider Demographics
NPI:1811088388
Name:KUTCHER, THEODORE JOHN II (MD)
Entity type:Individual
Prefix:DR
First Name:THEODORE
Middle Name:JOHN
Last Name:KUTCHER
Suffix:II
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:24 CEDAR ST
Mailing Address - Street 2:
Mailing Address - City:NARRAGANSETT
Mailing Address - State:RI
Mailing Address - Zip Code:02882-3930
Mailing Address - Country:US
Mailing Address - Phone:401-782-1254
Mailing Address - Fax:401-782-1254
Practice Address - Street 1:11 FRIENDSHIP ST
Practice Address - Street 2:DEPARTMENT OF DIAGNOSTIC IMAGING
Practice Address - City:NEWPORT
Practice Address - State:RI
Practice Address - Zip Code:02840-2209
Practice Address - Country:US
Practice Address - Phone:401-845-4253
Practice Address - Fax:401-848-6008
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
RI088232085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI7005421Medicaid
RIG27663Medicare UPIN