Provider Demographics
NPI:1053382168
Name:KNUTSON, DAVID W (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:W
Last Name:KNUTSON
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:22460 FAIRGALE FARM LN
Mailing Address - Street 2:
Mailing Address - City:CHESTERTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21620-4000
Mailing Address - Country:US
Mailing Address - Phone:410-810-4508
Mailing Address - Fax:410-810-0252
Practice Address - Street 1:100 BROWN ST
Practice Address - Street 2:
Practice Address - City:CHESTERTOWN
Practice Address - State:MD
Practice Address - Zip Code:21620-1435
Practice Address - Country:US
Practice Address - Phone:410-810-3408
Practice Address - Fax:410-810-0252
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD0060938207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD377SMedicare ID - Type Unspecified
MDB72252Medicare UPIN