Healthcare Provider Details

I. General information

NPI: 1710486188
Provider Name (Legal Business Name): MICHAEL GUTHRIE MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2018
Last Update Date: 02/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2305 N BROAD ST
PHILADELPHIA PA
19132-4504
US

IV. Provider business mailing address

764 N TAYLOR ST
PHILADELPHIA PA
19130-2512
US

V. Phone/Fax

Practice location:
  • Phone: 215-432-7804
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License NumberBG6427644
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberBG6427644
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberBG6427644
License Number StatePA

VIII. Authorized Official

Name: DR. MICHAEL GUTHRIE
Title or Position: PRESIDENT
Credential: MD
Phone: 215-432-7804