Provider Demographics
NPI:1093744583
Name:GUTERSON, JOHN (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:GUTERSON
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 1:2345 MURRAY AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15217-2352
Mailing Address - Country:US
Mailing Address - Phone:412-421-6770
Mailing Address - Fax:412-421-6596
Practice Address - Street 1:2345 MURRAY AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15217-2352
Practice Address - Country:US
Practice Address - Phone:412-421-6770
Practice Address - Fax:412-421-6596
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD055893L2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0015469790007Medicaid
GU789603Medicare ID - Type Unspecified
PA0015469790007Medicaid