Provider Demographics
NPI:1114049335
Name:PHILIP C. GUTHERZ, MD
Entity Type:Organization
Organization Name:PHILIP C. GUTHERZ, MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:C
Authorized Official - Last Name:GUTHERZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-253-7150
Mailing Address - Street 1:700 MAPLE AVENUE
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:HONESDALE
Mailing Address - State:PA
Mailing Address - Zip Code:18431
Mailing Address - Country:US
Mailing Address - Phone:570-253-7150
Mailing Address - Fax:
Practice Address - Street 1:700 MAPLE AVENUE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:HONESDALE
Practice Address - State:PA
Practice Address - Zip Code:18431
Practice Address - Country:US
Practice Address - Phone:570-253-7150
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-06
Last Update Date:2010-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD038651E207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty