Provider Demographics
NPI:1356347033
Name:GATTUSO, JOSEPH W JR (MD)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:W
Last Name:GATTUSO
Suffix:JR
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 1:1321 11TH AVE
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:PA
Mailing Address - Zip Code:16601-3301
Mailing Address - Country:US
Mailing Address - Phone:814-942-2411
Mailing Address - Fax:814-942-0510
Practice Address - Street 1:1321 11TH AVE
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16601-3301
Practice Address - Country:US
Practice Address - Phone:814-942-2411
Practice Address - Fax:814-942-0510
Is Sole Proprietor?:No
Enumeration Date:2005-06-27
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD038504E207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0010868600006Medicaid
PA142500OtherBCBS INDIVIDUAL
PA1034473OtherGATEWAY
PA142500Medicare ID - Type Unspecified
PA0010868600006Medicaid