Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | 01011247618 | VA |
NPI | 1902063092 |
---|---|
Provider Name | Dr. Kevin Charles Lutta |
First Address | Baltimore, MD 21275-5420 |
Second Address | Herndon, VA 20171-4095 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/05/2008 |
Last Update Date | 29/06/2015 |