Provider Demographics
NPI:1992974679
Name:GUSICK, EDWARD
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:
Last Name:GUSICK
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 BELLEFONTE AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:LOCK HAVEN
Mailing Address - State:PA
Mailing Address - Zip Code:17745-1237
Mailing Address - Country:US
Mailing Address - Phone:570-858-5328
Mailing Address - Fax:
Practice Address - Street 1:1201 GRAMPIAN BLVD
Practice Address - Street 2:SUITE 2F
Practice Address - City:WILLIAMSPORT
Practice Address - State:PA
Practice Address - Zip Code:17701-1900
Practice Address - Country:US
Practice Address - Phone:570-321-2020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-26
Last Update Date:2025-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS016038207RS0010X, 207RS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RS0010XAllopathic & Osteopathic PhysiciansInternal MedicineSports Medicine