Basic Information
| Provider Information | |||||||||
| NPI: | 1629073549 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KREUTZ | ||||||||
| FirstName: | BERNY | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 791372 | ||||||||
| Address2: | |||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 21279 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3016088375 | ||||||||
| FaxNumber: | 3016083979 | ||||||||
| Practice Location | |||||||||
| Address1: | 6420 ROCKLEDGE DR | ||||||||
| Address2: | 2200 | ||||||||
| City: | BETHESDA | ||||||||
| State: | MD | ||||||||
| PostalCode: | 208177837 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3018966880 | ||||||||
| FaxNumber: | 3018966868 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/16/2005 | ||||||||
| LastUpdateDate: | 12/04/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | D0012566 | MD | Y | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | 30056 | 01 | MDIPA | OTHER | 415096100 | 05 | MD | MEDICAID | 5062BJ | 01 | BC/BS | OTHER | 212221900 | 05 | MD | MEDICAID |