Provider Demographics
NPI:1285829101
Name:GUSTILO-ASHBY, ARLAN MARCUS (MD)
Entity Type:Individual
Prefix:DR
First Name:ARLAN
Middle Name:MARCUS
Last Name:GUSTILO-ASHBY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:ARLAN
Other - Middle Name:MARCUS
Other - Last Name:GUSTILO- ASHBY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:7740 WASHINGTON VILLAGE DR STE 160
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45459-4056
Mailing Address - Country:US
Mailing Address - Phone:937-436-9825
Mailing Address - Fax:937-433-6508
Practice Address - Street 1:7740 WASHNGTON VLG DR STE 160
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:45459-4056
Practice Address - Country:US
Practice Address - Phone:937-436-9825
Practice Address - Fax:937-433-6508
Is Sole Proprietor?:No
Enumeration Date:2007-09-13
Last Update Date:2021-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-084685207VG0400X, 208800000X
OH35084685207VF0040X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VF0040XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyFemale Pelvic Medicine and Reconstructive Surgery
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
No208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2559315Medicaid
OH4152934Medicare PIN
H71388Medicare UPIN
OHH183290Medicare PIN