MEDICARE: GAUTAMI GUHA MD, PH. D

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	207R00000X	Internal Medicine Physician	211584	NY

General Provider Information

NPI Number	:	1568470912
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GAUTAMI GUHA MD, PH. D

Provider Business Mailing Address
First Line	:	350 SPRAIN RD
Second Line	:
City	:	SCARSDALE
State	:	NY
Zip	:	10583-1222
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	138 ALBANY POST RD
Second Line	:
City	:	MONTROSE
State	:	NY
Zip	:	10548-1434
Country	:	US
Telephone Number	:	914-737-4400
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/03/2006
Last Update Date	:	07/08/2007

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