Basic Information
| Provider Information | |||||||||
| NPI: | 1295709186 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GUTTMAN | ||||||||
| FirstName: | MARC | ||||||||
| MiddleName: | L. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 202 GRASSY HILL RD | ||||||||
| Address2: | |||||||||
| City: | EAST LYME | ||||||||
| State: | CT | ||||||||
| PostalCode: | 063331012 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8606910328 | ||||||||
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| Practice Location | |||||||||
| Address1: | 112 MANSFIELD AVE | ||||||||
| Address2: | |||||||||
| City: | WILLIMANTIC | ||||||||
| State: | CT | ||||||||
| PostalCode: | 062262045 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8604569116 | ||||||||
| FaxNumber: | 8609636368 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/15/2006 | ||||||||
| LastUpdateDate: | 07/29/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 041783 | CT | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.