Provider Demographics
NPI:1215132337
Name:CUTLER, SAMANTHA GREY (MD)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:GREY
Last Name:CUTLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SAMANTHA
Other - Middle Name:JOY
Other - Last Name:GREY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7015C MANCHESTER BLVD
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22310-3253
Mailing Address - Country:US
Mailing Address - Phone:703-971-6900
Mailing Address - Fax:
Practice Address - Street 1:13001 SUMMIT SCHOOL RD
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192-2903
Practice Address - Country:US
Practice Address - Phone:703-494-4811
Practice Address - Fax:703-494-2098
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-19
Last Update Date:2019-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101241587208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics