MEDICARE: GUTHRIE MEDICAL GROUP, P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	291U00000X	Clinical Medical Laboratory
2	207Q00000X	Family Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	GU631530	OTHER	PA	HIGHMARK BLUE SHIELD

General Provider Information

NPI Number	:	1376592493
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GUTHRIE MEDICAL GROUP, P.C.

Provider Business Mailing Address
First Line	:	1 GUTHRIE SQ
Second Line	:
City	:	SAYRE
State	:	PA
Zip	:	18840-1625
Country	:	US
Telephone Number	:	570-888-5858
Fax Number	:

Provider Business Practice Location Address
First Line	:	285 GUTHRIE DR
Second Line	:
City	:	TROY
State	:	PA
Zip	:	16947-8115
Country	:	US
Telephone Number	:	570-297-4104
Fax Number	:	570-297-2066

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JOSEPH A SCOPELLITI
Credential	:	MD
Telephone Number	:	570-888-5858

Provider Enumeration Date	:	05/08/2006
Last Update Date	:	02/28/2014

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