Healthcare Provider Details

I. General information

NPI: 1609296219
Provider Name (Legal Business Name): BRIAN GUZZETTI DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2014
Last Update Date: 07/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UNIT 2022
APO AP
96264
US

IV. Provider business mailing address

PSC 2 BOX 2358
APO AP
96264-0024
US

V. Phone/Fax

Practice location:
  • Phone: 315-784-4842
  • Fax:
Mailing address:
  • Phone: 350-782-4842
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS018547
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: