Provider Demographics
NPI:1730396540
Name:GUSCHWAN, MARIANNE TERESE (MD)
Entity type:Individual
Prefix:
First Name:MARIANNE
Middle Name:TERESE
Last Name:GUSCHWAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:155 E 31ST ST
Mailing Address - Street 2:SUITE #25-L
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-6800
Mailing Address - Country:US
Mailing Address - Phone:212-448-9450
Mailing Address - Fax:212-251-0137
Practice Address - Street 1:155 E 31ST ST
Practice Address - Street 2:SUITE #25-L
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-6800
Practice Address - Country:US
Practice Address - Phone:212-448-9450
Practice Address - Fax:212-251-0137
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2010-12-31
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY1963512084P0800X, 2084P0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY61M951Medicare UPIN