Healthcare Provider Details

I. General information

NPI: 1538133343
Provider Name (Legal Business Name): ELLEN MARIE GUTHRIE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/16/2006
Last Update Date: 09/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13 BRADLEE RD
MEDFORD MA
02155
US

IV. Provider business mailing address

13 BRADLEE RD
MEDFORD MA
02155-3110
US

V. Phone/Fax

Practice location:
  • Phone: 781-395-1110
  • Fax: 781-395-8553
Mailing address:
  • Phone: 781-395-1110
  • Fax: 781-395-8553

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number60673
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: