Provider Demographics
NPI:1942207691
Name:GUTHERZ, PHILIP C (MD)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:C
Last Name:GUTHERZ
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 1:601 PARK ST
Mailing Address - Street 2:
Mailing Address - City:HONESDALE
Mailing Address - State:PA
Mailing Address - Zip Code:18431-1445
Mailing Address - Country:US
Mailing Address - Phone:570-253-6846
Mailing Address - Fax:
Practice Address - Street 1:700 MAPLE AVE
Practice Address - Street 2:
Practice Address - City:HONESDALE
Practice Address - State:PA
Practice Address - Zip Code:18431-1410
Practice Address - Country:US
Practice Address - Phone:570-253-7150
Practice Address - Fax:570-253-7152
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2017-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD038651E173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173000000XOther Service ProvidersLegal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001332OtherFIRST PRIORITY HEALTH
PA10883OtherGEISINGER HEALTH PLAN
PA435715OtherBLUE CROSS
PA0011041080002Medicaid
PAB41796Medicare UPIN
PAGU435715Medicare ID - Type UnspecifiedMEDICARE