Provider Demographics
NPI:1003960469
Name:GUT, MARIE L (PA-C)
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:L
Last Name:GUT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:MARIE
Other - Middle Name:LOUISE
Other - Last Name:GUT-MURPHY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C
Mailing Address - Street 1:PO BOX 415348
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-5348
Mailing Address - Country:US
Mailing Address - Phone:800-225-8885
Mailing Address - Fax:508-334-1977
Practice Address - Street 1:55 LAKE AVE N
Practice Address - Street 2:DEPARTMENT OF ORTHOPEDICS
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01655-0002
Practice Address - Country:US
Practice Address - Phone:508-334-2372
Practice Address - Fax:508-334-3408
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2011-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA160363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant