Provider Demographics
NPI:1083608145
Name:GUTSIN, RICHARD A (DO)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:A
Last Name:GUTSIN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:3720 SHIPYARD BLVD
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-6147
Mailing Address - Country:US
Mailing Address - Phone:910-796-3212
Mailing Address - Fax:910-796-3216
Practice Address - Street 1:3720 SHIPYARD BLVD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-6147
Practice Address - Country:US
Practice Address - Phone:910-796-3212
Practice Address - Fax:910-796-3216
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-06
Last Update Date:2018-10-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NCNC9500364207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7937920Medicaid
NC7937920Medicaid
NC2214061BMedicare ID - Type Unspecified