Provider Demographics
NPI:1063579431
Name:GUTMANN, JACQUELINE (MD)
Entity type:Individual
Prefix:DR
First Name:JACQUELINE
Middle Name:
Last Name:GUTMANN
Suffix:
Gender:F
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:735 FITZWATERTOWN RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:WILLOW GROVE
Mailing Address - State:PA
Mailing Address - Zip Code:19090-1338
Mailing Address - Country:US
Mailing Address - Phone:215-938-1515
Mailing Address - Fax:215-938-8756
Practice Address - Street 1:833 CHESTNUT ST
Practice Address - Street 2:SUITE C-152
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-4414
Practice Address - Country:US
Practice Address - Phone:215-922-1556
Practice Address - Fax:215-922-1565
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2014-10-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMD047469L207VE0102X, 207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive Endocrinology
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAD98418Medicare UPIN