MEDICARE: MR. RICHARD THOMAS GUNN NP

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	363LG0600X	Gerontology Nurse Practitioner	208760	MA

General Provider Information

NPI Number	:	1558321935
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RICHARD THOMAS GUNN NP

Provider Business Mailing Address
First Line	:	22 TEMPLE RD
Second Line	:
City	:	MARSHFIELD
State	:	MA
Zip	:	02050-5348
Country	:	US
Telephone Number	:	508-367-2702
Fax Number	:

Provider Business Practice Location Address
First Line	:	1135 MORTON ST
Second Line	:
City	:	MATTAPAN
State	:	MA
Zip	:	02126-2834
Country	:	US
Telephone Number	:	617-533-2400
Fax Number	:

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

Provider Enumeration Date	:	03/28/2006
Last Update Date	:	04/08/2011

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