Healthcare Provider Details

I. General information

NPI: 1528597267
Provider Name (Legal Business Name): ALLYSON JULIA GUTSTEIN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/07/2017
Last Update Date: 08/13/2020
Certification Date: 08/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

143 LONGWATER DR
NORWELL MA
02061-1683
US

IV. Provider business mailing address

55 FOGG RD # 73
SOUTH WEYMOUTH MA
02190-2432
US

V. Phone/Fax

Practice location:
  • Phone: 781-878-5200
  • Fax: 781-878-6750
Mailing address:
  • Phone: 781-878-5200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number283202
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: