Provider Demographics
NPI:1558568196
Name:DAVID M GUYETTE MD PC
Entity Type:Organization
Organization Name:DAVID M GUYETTE MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:FRANCES
Authorized Official - Middle Name:
Authorized Official - Last Name:GUYETTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-321-6463
Mailing Address - Street 1:600 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:MALDEN
Mailing Address - State:MA
Mailing Address - Zip Code:02148
Mailing Address - Country:US
Mailing Address - Phone:781-321-6463
Mailing Address - Fax:781-279-2739
Practice Address - Street 1:600 MAIN ST
Practice Address - Street 2:
Practice Address - City:MALDEN
Practice Address - State:MA
Practice Address - Zip Code:02148-3919
Practice Address - Country:US
Practice Address - Phone:781-321-6463
Practice Address - Fax:781-279-2739
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-28
Last Update Date:2012-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA42990156FX1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1101XEye and Vision Services ProvidersTechnician/TechnologistOphthalmic AssistantGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAB27158Medicare ID - Type UnspecifiedPROVIDER NUMBER
MAA34822Medicare UPIN