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NPI Code Detail

MEDICARE: RICHARD GUSSO M.D.

MEDICARE: RICHARD GUSSO 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
1208M00000XHospitalist Physician45923TN
2207R00000XInternal Medicine Physician45923TN

General Provider Information

NPI Number : 1780673434
Entity Type Code : Individual
Provider Name (Legal Business Name) : RICHARD GUSSO M.D.
Provider Business Mailing Address
First Line : 2525 DESALES AVE
Second Line :
City : CHATTANOOGA
State : TN
Zip : 37404-1161
Country : US
Telephone Number : 423-495-2620
Fax Number : 423-495-2625
Provider Business Practice Location Address
First Line : 2525 DESALES AVE
Second Line :
City : CHATTANOOGA
State : TN
Zip : 37404-1161
Country : US
Telephone Number : 423-495-2620
Fax Number : 423-495-2625
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/17/2005
Last Update Date : 12/02/2010

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