Provider Demographics
NPI:1558308957
Name:GUTTA, JAYANTH K (MD)
Entity Type:Individual
Prefix:MR
First Name:JAYANTH
Middle Name:K
Last Name:GUTTA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:950 S MAIN ST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:CELINA
Mailing Address - State:OH
Mailing Address - Zip Code:45822-2479
Mailing Address - Country:US
Mailing Address - Phone:567-890-7138
Mailing Address - Fax:419-586-0812
Practice Address - Street 1:950 S MAIN ST
Practice Address - Street 2:SUITE 3
Practice Address - City:CELINA
Practice Address - State:OH
Practice Address - Zip Code:45822-2479
Practice Address - Country:US
Practice Address - Phone:419-586-3017
Practice Address - Fax:419-586-3174
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2013-08-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH35087081207RP1001X, 207RC0200X
OH35-087081207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2631370Medicaid
OHF19756Medicare UPIN
OH4173102Medicare PIN