MEDICARE: DR. GUSTAVO SOARES GUANDALINI M.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	207RC0001X	Clinical Cardiac Electrophysiology Physician	MD465463	PA
2	207RC0000X	Cardiovascular Disease Physician	MD465463	PA
3	207R00000X	Internal Medicine Physician	MD465463	PA

General Provider Information

NPI Number	:	1669763728
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GUSTAVO SOARES GUANDALINI M.D.

Provider Business Mailing Address
First Line	:	3400 SPRUCE ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19104-4206
Country	:	US
Telephone Number	:	215-662-7355
Fax Number	:	215-349-8444

Provider Business Practice Location Address
First Line	:	3400 SPRUCE ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19104-4206
Country	:	US
Telephone Number	:	215-662-7355
Fax Number	:	215-349-8444

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

Provider Enumeration Date	:	04/25/2011
Last Update Date	:	02/06/2026

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