Healthcare Provider Details

I. General information

NPI: 1396846911
Provider Name (Legal Business Name): ANDREW GUTOWSKI D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 12/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

907 SUMNER ST M201
STOUGHTON MA
02072
US

IV. Provider business mailing address

907 SUMNER ST M201
STOUGHTON MA
02072
US

V. Phone/Fax

Practice location:
  • Phone: 781-344-2325
  • Fax: 781-341-8544
Mailing address:
  • Phone: 781-344-2325
  • Fax: 781-341-8544

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number75081
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: