MEDICARE: PAUL J GAUSMAN DO

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	207Q00000X	Family Medicine Physician	OS009013L	PA

General Provider Information

NPI Number	:	1558346577
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAUL J GAUSMAN DO

Provider Business Mailing Address
First Line	:	4247 W RIDGE RD STE 105
Second Line	:
City	:	ERIE
State	:	PA
Zip	:	16506-1746
Country	:	US
Telephone Number	:	814-838-2468
Fax Number	:

Provider Business Practice Location Address
First Line	:	4247 W RIDGE RD STE 105
Second Line	:
City	:	ERIE
State	:	PA
Zip	:	16506-1746
Country	:	US
Telephone Number	:	814-838-2468
Fax Number	:

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

Provider Enumeration Date	:	12/13/2005
Last Update Date	:	10/02/2020

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