Provider Demographics
NPI:1598261695
Name:GUNTMAN, LANDON PAULL (MD)
Entity Type:Individual
Prefix:
First Name:LANDON
Middle Name:PAULL
Last Name:GUNTMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:785 WILLIAMS ST # 172
Mailing Address - Street 2:
Mailing Address - City:LONGMEADOW
Mailing Address - State:MA
Mailing Address - Zip Code:01106-2063
Mailing Address - Country:US
Mailing Address - Phone:203-598-6045
Mailing Address - Fax:
Practice Address - Street 1:785 WILLIAMS ST # 172
Practice Address - Street 2:
Practice Address - City:LONGMEADOW
Practice Address - State:MA
Practice Address - Zip Code:01106-2063
Practice Address - Country:US
Practice Address - Phone:203-598-6045
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-05
Last Update Date:2021-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA285865208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice