Provider Demographics
NPI:1851317036
Name:GUGLIELMI, GWEN E (MD)
Entity Type:Individual
Prefix:DR
First Name:GWEN
Middle Name:E
Last Name:GUGLIELMI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 MAYBURY HILL ROAD
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08540-3617
Mailing Address - Country:US
Mailing Address - Phone:609-497-0196
Mailing Address - Fax:732-821-6675
Practice Address - Street 1:65 MAYBURY HILL ROAD
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:NJ
Practice Address - Zip Code:08540-3617
Practice Address - Country:US
Practice Address - Phone:609-497-0196
Practice Address - Fax:732-821-6675
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2012-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA057164002085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5352703Medicaid
NJA66635Medicare UPIN
NJ5352703Medicaid