Provider Demographics
NPI:1861759086
Name:MARCIA A. GUTOWICZ MD LLC
Entity type:Organization
Organization Name:MARCIA A. GUTOWICZ MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARCIA
Authorized Official - Middle Name:
Authorized Official - Last Name:GUTOWICZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:267-471-1711
Mailing Address - Street 1:50 TOWNSHIP LINE RD
Mailing Address - Street 2:SUITE 222
Mailing Address - City:ELKINS PARK
Mailing Address - State:PA
Mailing Address - Zip Code:19027-2249
Mailing Address - Country:US
Mailing Address - Phone:215-663-9117
Mailing Address - Fax:215-947-2593
Practice Address - Street 1:50 TOWNSHIP LINE RD
Practice Address - Street 2:SUITE 222
Practice Address - City:ELKINS PARK
Practice Address - State:PA
Practice Address - Zip Code:19027-2249
Practice Address - Country:US
Practice Address - Phone:215-663-9117
Practice Address - Fax:215-947-2593
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-12
Last Update Date:2012-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD020794E2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
B40796Medicare UPIN