Provider Demographics
NPI:1376636019
Name:GUTTING, JEFFREY W (PA)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:W
Last Name:GUTTING
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 FOULK ROAD
Mailing Address - Street 2:SUITE 2A
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19803
Mailing Address - Country:US
Mailing Address - Phone:302-661-1661
Mailing Address - Fax:302-661-1001
Practice Address - Street 1:2600 GLASGOW AVENUE
Practice Address - Street 2:SUITE 221
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19702
Practice Address - Country:US
Practice Address - Phone:302-834-7676
Practice Address - Fax:302-834-9202
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2010-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC50000376363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant