Healthcare Provider Details

I. General information

NPI: 1750730016
Provider Name (Legal Business Name): RAFAEL GUZMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2016
Last Update Date: 06/09/2022
Certification Date: 06/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1656 CHAMPLIN AVE
UTICA NY
13502-4830
US

IV. Provider business mailing address

2209 GENESEE ST BUSINESS OFFICE ROOM 315
UTICA NY
13501-1807
US

V. Phone/Fax

Practice location:
  • Phone: 315-624-6829
  • Fax:
Mailing address:
  • Phone: 315-801-8534
  • Fax: 315-801-8391

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number299929
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number299929
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: