Provider Demographics
NPI:1154424109
Name:GUTOWICZ, MARCIA
Entity type:Individual
Prefix:
First Name:MARCIA
Middle Name:
Last Name:GUTOWICZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3871 DEMPSEY LN
Mailing Address - Street 2:SUITE 222
Mailing Address - City:HUNTINGDON VALLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19006-1901
Mailing Address - Country:US
Mailing Address - Phone:267-471-1711
Mailing Address - Fax:215-947-2593
Practice Address - Street 1:727 WELSH RD
Practice Address - Street 2:SUITE 203
Practice Address - City:HUNTINGDON VALLEY
Practice Address - State:PA
Practice Address - Zip Code:19006-1901
Practice Address - Country:US
Practice Address - Phone:215-947-0153
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-06
Last Update Date:2014-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD020794E208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0045150000OtherKHPE
PA0105193503OtherAMERICHOICE
PW181277OtherBLUE SHIELD
PAP2020972OtherOXFORD
PA0045150000OtherAMERIHEALTH
PA1011551OtherKEYSTONE MERCY
PA55778OtherUSHC
PA0010519350006Medicaid
PA10998OtherHEALTH PARTNERS
PA55778OtherUSHC
PA0105193503OtherAMERICHOICE