MEDICARE: LAVERNE D GUGINO MD

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	46992	MA
2	2084N0600X	Clinical Neurophysiology Physician	46992	MA

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
3	J01021	OTHER	MA	BLUE CROSS BLUE SHIELD
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1760465942
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAVERNE D GUGINO MD

Provider Business Mailing Address
First Line	:	3 MARYLAND FARMS STE 200
Second Line	:
City	:	BRENTWOOD
State	:	TN
Zip	:	37027-5005
Country	:	US
Telephone Number	:	615-345-5400
Fax Number	:	888-468-6603

Provider Business Practice Location Address
First Line	:	119 SUMMIT AVE
Second Line	:
City	:	WINTHROP
State	:	MA
Zip	:	02152
Country	:	US
Telephone Number	:	617-418-0478
Fax Number	:

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

Provider Enumeration Date	:	11/22/2005
Last Update Date	:	12/20/2018

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