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NPI Code Detail

MEDICARE: CRAIG S. GUSTAFSON M.D.

MEDICARE: CRAIG S. GUSTAFSON 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
1207Q00000XFamily Medicine Physician153873MA

Other Identifiers

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

General Provider Information

NPI Number : 1780660845
Entity Type Code : Individual
Provider Name (Legal Business Name) : CRAIG S. GUSTAFSON M.D.
Provider Business Mailing Address
First Line : 233 AYER RD
Second Line :
City : HARVARD
State : MA
Zip : 01451-1131
Country : US
Telephone Number : 978-772-0698
Fax Number : 978-772-0024
Provider Business Practice Location Address
First Line : 233 AYER RD
Second Line :
City : HARVARD
State : MA
Zip : 01451-1131
Country : US
Telephone Number : 978-772-0698
Fax Number : 978-772-0024
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/21/2005
Last Update Date : 09/21/2023

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