Provider Demographics
NPI:1295709186
Name:GUTTMAN, MARC L (MD)
Entity type:Individual
Prefix:
First Name:MARC
Middle Name:L
Last Name:GUTTMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 GRASSY HILL RD
Mailing Address - Street 2:
Mailing Address - City:EAST LYME
Mailing Address - State:CT
Mailing Address - Zip Code:06333-1012
Mailing Address - Country:US
Mailing Address - Phone:860-691-0328
Mailing Address - Fax:
Practice Address - Street 1:112 MANSFIELD AVE
Practice Address - Street 2:
Practice Address - City:WILLIMANTIC
Practice Address - State:CT
Practice Address - Zip Code:06226-2045
Practice Address - Country:US
Practice Address - Phone:860-456-9116
Practice Address - Fax:860-963-6368
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2008-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT041783207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
I13487Medicare UPIN
930001207Medicare ID - Type Unspecified
CT930001554Medicare PIN