Provider Demographics
NPI:1811079536
Name:GUTWEILER, JORDAN RICHARD (MD)
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:RICHARD
Last Name:GUTWEILER
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 1:300 MOUNT AUBURN ST
Mailing Address - Street 2:SUITE 407
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02138-5600
Mailing Address - Country:US
Mailing Address - Phone:617-868-7456
Mailing Address - Fax:617-868-9243
Practice Address - Street 1:300 MOUNT AUBURN ST
Practice Address - Street 2:SUITE 407
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02138-5600
Practice Address - Country:US
Practice Address - Phone:617-868-7456
Practice Address - Fax:617-868-9243
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2014-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA230079208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery