Provider Demographics
NPI:1720085301
Name:GUTT, FREDERICK PAUL (MD)
Entity Type:Individual
Prefix:
First Name:FREDERICK
Middle Name:PAUL
Last Name:GUTT
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 1:28 DEER TRAIL DR
Mailing Address - Street 2:
Mailing Address - City:MAHOPAC
Mailing Address - State:NY
Mailing Address - Zip Code:10541-4815
Mailing Address - Country:US
Mailing Address - Phone:914-804-5050
Mailing Address - Fax:845-621-2221
Practice Address - Street 1:28 DEER TRAIL DR
Practice Address - Street 2:
Practice Address - City:MAHOPAC
Practice Address - State:NY
Practice Address - Zip Code:10541-4815
Practice Address - Country:US
Practice Address - Phone:914-804-5050
Practice Address - Fax:845-621-2221
Is Sole Proprietor?:No
Enumeration Date:2005-06-28
Last Update Date:2023-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD430364207L00000X
NY219156207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02135899Medicaid
PA1017875810001Medicaid
NY6K8881Medicare PIN
PA159347VKCMedicare PIN
NYH33113Medicare UPIN