Provider Demographics
NPI:1619975752
Name:CUTRONE, MARTIN BERNARD JR (MD)
Entity type:Individual
Prefix:
First Name:MARTIN
Middle Name:BERNARD
Last Name:CUTRONE
Suffix:JR
Gender:M
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:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:704-316-1074
Mailing Address - Fax:704-316-1077
Practice Address - Street 1:14035 GRANDIFLORA DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28278-8456
Practice Address - Country:US
Practice Address - Phone:704-316-1074
Practice Address - Fax:704-316-1077
Is Sole Proprietor?:No
Enumeration Date:2005-07-12
Last Update Date:2023-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200301104207R00000X, 207RC0000X
NC2003-01104207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCN01104Medicaid
NC89135EFMedicaid
NC2021975Medicare PIN
NC89135EFMedicaid