Provider Demographics
NPI:1114906641
Name:UTZ, JANET L (MD)
Entity type:Individual
Prefix:
First Name:JANET
Middle Name:L
Last Name:UTZ
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 1:367 S. GULPH RD
Mailing Address - Street 2:ATT: IPM CREDENTIALING
Mailing Address - City:KING OF PRUSSIA
Mailing Address - State:PA
Mailing Address - Zip Code:19406-3121
Mailing Address - Country:US
Mailing Address - Phone:803-641-4874
Mailing Address - Fax:
Practice Address - Street 1:137 MIRACLE DRIVE
Practice Address - Street 2:
Practice Address - City:AIKEN
Practice Address - State:SC
Practice Address - Zip Code:29801
Practice Address - Country:US
Practice Address - Phone:803-641-4874
Practice Address - Fax:803-641-0436
Is Sole Proprietor?:No
Enumeration Date:2006-01-12
Last Update Date:2018-06-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA045133207RC0000X
SC52333207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP3804Medicare ID - Type Unspecified
H76245Medicare UPIN