Provider Demographics
NPI:1538145263
Name:GUNOVICH, RICHARD ALAN (DO)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:ALAN
Last Name:GUNOVICH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 449
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:OH
Mailing Address - Zip Code:45750-0449
Mailing Address - Country:US
Mailing Address - Phone:740-374-4500
Mailing Address - Fax:740-374-5887
Practice Address - Street 1:800 WAYNE ST STE 112
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:OH
Practice Address - Zip Code:45750-3309
Practice Address - Country:US
Practice Address - Phone:740-373-4288
Practice Address - Fax:740-373-4254
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-15
Last Update Date:2021-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34006878207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000696929OtherANTHEM
OH2080215Medicaid
OHP00327899OtherRRMCR
OH000000379607OtherANTHEM
WV0010530000Medicaid
4175542Medicare PIN
OH7419861Medicare PIN
OH2080215Medicaid