Provider Demographics
NPI:1932597416
Name:KUTZKE, ORNELA DERVISHAJ (MD)
Entity Type:Individual
Prefix:DR
First Name:ORNELA
Middle Name:DERVISHAJ
Last Name:KUTZKE
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 1:5530 WISCONSIN AVE STE 711
Mailing Address - Street 2:
Mailing Address - City:CHEVY CHASE
Mailing Address - State:MD
Mailing Address - Zip Code:20815-4401
Mailing Address - Country:US
Mailing Address - Phone:917-704-0465
Mailing Address - Fax:
Practice Address - Street 1:5530 WISCONSIN AVE STE 711
Practice Address - Street 2:
Practice Address - City:CHEVY CHASE
Practice Address - State:MD
Practice Address - Zip Code:20815-4401
Practice Address - Country:US
Practice Address - Phone:917-704-0465
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-06
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD467781208200000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery