Healthcare Provider Details

I. General information

NPI: 1376636019
Provider Name (Legal Business Name): JEFFREY W GUTTING PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 12/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 GLASGOW AVENUE SUITE 221
NEWARK DE
19702
US

IV. Provider business mailing address

701 FOULK ROAD SUITE 2A
WILMINGTON DE
19803
US

V. Phone/Fax

Practice location:
  • Phone: 302-834-7676
  • Fax: 302-834-9202
Mailing address:
  • Phone: 302-661-1661
  • Fax: 302-661-1001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberC50000376
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: