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General NPI Number Information
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NPI Number | 1649320177
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Entity Type | Individual
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Provider Name | THOMAS GORDON GUTHEIL MD
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Gender | Male
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Dates
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Enumeration Date | 01/10/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 180 MORTON ST
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City | JAMAICA PLAIN
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State | MA
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Zip | 02130-3735
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Country | US
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Telephone | 617-626-9659
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Fax |
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Provider Business Mailing Address
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Address Line | 6 WELLMAN ST
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City | BROOKLINE
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State | MA
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Zip | 02446-2831
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Country | US
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Telephone | 617-734-9519
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084F0202X
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Taxonomy Name | Forensic Psychiatry Physician
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License Number | 31729
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License Number State | MA
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