Provider Demographics
NPI:1811411093
Name:BRITTANY ZUMPETTA GUSIC
Entity Type:Organization
Organization Name:BRITTANY ZUMPETTA GUSIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LINDSAY
Authorized Official - Middle Name:
Authorized Official - Last Name:CROTZER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-263-8911
Mailing Address - Street 1:101 MARCLEY DR
Mailing Address - Street 2:
Mailing Address - City:MARTINSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:25401-2977
Mailing Address - Country:US
Mailing Address - Phone:304-263-8911
Mailing Address - Fax:304-263-9450
Practice Address - Street 1:209 CLOVER ST
Practice Address - Street 2:
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25404-3803
Practice Address - Country:US
Practice Address - Phone:304-263-8911
Practice Address - Fax:304-263-9450
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-31
Last Update Date:2017-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV25893207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty