MEDICARE: MARCIA A. GUTOWICZ MD LLC

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	2086S0129X	Vascular Surgery Physician	MD020794E	PA

General Provider Information

NPI Number	:	1861759086
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARCIA A. GUTOWICZ MD LLC

Provider Business Mailing Address
First Line	:	50 TOWNSHIP LINE RD
Second Line	:	SUITE 222
City	:	ELKINS PARK
State	:	PA
Zip	:	19027-2249
Country	:	US
Telephone Number	:	215-663-9117
Fax Number	:	215-947-2593

Provider Business Practice Location Address
First Line	:	50 TOWNSHIP LINE RD
Second Line	:	SUITE 222
City	:	ELKINS PARK
State	:	PA
Zip	:	19027-2249
Country	:	US
Telephone Number	:	215-663-9117
Fax Number	:	215-947-2593

Authorized Official
Title or Position	:	OWNER
Name	:	DR. MARCIA GUTOWICZ
Credential	:	MD
Telephone Number	:	267-471-1711

Provider Enumeration Date	:	04/12/2012
Last Update Date	:	04/12/2012

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