Provider Demographics
NPI:1457557456
Name:GUTOWICZ, LORRAINE F (MD)
Entity Type:Individual
Prefix:DR
First Name:LORRAINE
Middle Name:F
Last Name:GUTOWICZ
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 1:1717 ARCH ST FL 45
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19103-2835
Mailing Address - Country:US
Mailing Address - Phone:215-587-1916
Mailing Address - Fax:215-561-8590
Practice Address - Street 1:1717 ARCH ST
Practice Address - Street 2:45TH FLOOR
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19103-2713
Practice Address - Country:US
Practice Address - Phone:215-587-1916
Practice Address - Fax:215-561-8590
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-26
Last Update Date:2007-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PRMD022225E207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0501426Medicaid
PA0501426Medicaid
PAE63553Medicare UPIN