Healthcare Provider Details

I. General information

NPI: 1659584621
Provider Name (Legal Business Name): ROBERT L. GATTUSO, M.D., PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2007
Last Update Date: 09/20/2024
Certification Date: 09/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 MT CARMEL ROAD
PARKTON MD
21120
US

IV. Provider business mailing address

106 MT CARMEL ROAD
PARKTON MD
21120
US

V. Phone/Fax

Practice location:
  • Phone: 410-357-4500
  • Fax: 410-357-4570
Mailing address:
  • Phone: 410-357-4500
  • Fax: 410-357-4570

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberD0034622
License Number StateMD

VIII. Authorized Official

Name: DR. ROBERT L. GATTUSO
Title or Position: OWNER/PHYSICIAN
Credential: M.D., PA
Phone: 410-357-4500