MEDICARE: FREDERICK PAUL GUTT 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	207L00000X	Anesthesiology Physician	MD430364	PA
2	207L00000X	Anesthesiology Physician	219156	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1720085301
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FREDERICK PAUL GUTT M.D.

Provider Business Mailing Address
First Line	:	28 DEER TRAIL DR
Second Line	:
City	:	MAHOPAC
State	:	NY
Zip	:	10541-4815
Country	:	US
Telephone Number	:	914-804-5050
Fax Number	:	845-621-2221

Provider Business Practice Location Address
First Line	:	28 DEER TRAIL DR
Second Line	:
City	:	MAHOPAC
State	:	NY
Zip	:	10541-4815
Country	:	US
Telephone Number	:	914-804-5050
Fax Number	:	845-621-2221

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

Provider Enumeration Date	:	06/28/2005
Last Update Date	:	09/09/2023

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