Provider Demographics
NPI:1790887719
Name:GULDSETH, DAVID P (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:P
Last Name:GULDSETH
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 1:195 SCHOOL ST
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01944-1700
Mailing Address - Country:US
Mailing Address - Phone:978-526-4311
Mailing Address - Fax:978-525-2342
Practice Address - Street 1:195 SCHOOL ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:MA
Practice Address - Zip Code:01944-1700
Practice Address - Country:US
Practice Address - Phone:978-526-4311
Practice Address - Fax:978-525-2342
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2013-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA253729207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA5629934Medicaid
MA003099001OtherMEDICARE PTAN
MA110094388AMedicaid
MA003099001OtherMEDICARE PTAN
VA5629934Medicaid
VA00V083S29Medicare PIN