Provider Demographics
NPI:1740476399
Name:GUEVARRA, JOAN CATHERINE (MD)
Entity type:Individual
Prefix:DR
First Name:JOAN
Middle Name:CATHERINE
Last Name:GUEVARRA
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 1:14A JAYNE AVE
Mailing Address - Street 2:
Mailing Address - City:PATCHOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11772-2804
Mailing Address - Country:US
Mailing Address - Phone:631-475-0222
Mailing Address - Fax:
Practice Address - Street 1:59A NICHOLS RD
Practice Address - Street 2:
Practice Address - City:NESCONSET
Practice Address - State:NY
Practice Address - Zip Code:11767-2093
Practice Address - Country:US
Practice Address - Phone:631-656-6940
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-18
Last Update Date:2007-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY244374-1208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice