Provider Demographics
NPI:1629395272
Name:GATTUSO, ALISON LEIGH (DO)
Entity Type:Individual
Prefix:DR
First Name:ALISON
Middle Name:LEIGH
Last Name:GATTUSO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:ALISON
Other - Middle Name:LEIGH
Other - Last Name:DEGENNARO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:3601 A ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19134-1043
Mailing Address - Country:US
Mailing Address - Phone:215-427-4641
Mailing Address - Fax:215-427-8782
Practice Address - Street 1:3601 A ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19134-1043
Practice Address - Country:US
Practice Address - Phone:215-427-4641
Practice Address - Fax:215-427-8782
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-22
Last Update Date:2012-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS014754207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery