MEDICARE: BRIAN CHRISTOPHER GULLETT D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208D00000X	General Practice Physician	2218	WV

General Provider Information

NPI Number	:	1366594525
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIAN CHRISTOPHER GULLETT D.O.

Provider Business Mailing Address
First Line	:	343 ADAMIK RD
Second Line	:
City	:	CLARKSVILLE
State	:	PA
Zip	:	15322-7395
Country	:	US
Telephone Number	:	724-413-9923
Fax Number	:

Provider Business Practice Location Address
First Line	:	343 ADAMIK RD
Second Line	:
City	:	CLARKSVILLE
State	:	PA
Zip	:	15322-7395
Country	:	US
Telephone Number	:	724-413-9923
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/17/2007
Last Update Date	:	11/24/2009

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