Basic Information
Provider Information | |||||||||
NPI: | 1386688570 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | GUYTON | ||||||||
FirstName: | GREGORY | ||||||||
MiddleName: | P | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 3333 N CALVERT ST | ||||||||
Address2: | STE 400 | ||||||||
City: | BALTIMORE | ||||||||
State: | MD | ||||||||
PostalCode: | 21218 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4105546844 | ||||||||
FaxNumber: | 4105544326 | ||||||||
Practice Location | |||||||||
Address1: | 3333 N CALVERT ST | ||||||||
Address2: | STE 400 | ||||||||
City: | BALTIMORE | ||||||||
State: | MD | ||||||||
PostalCode: | 21218 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4105546844 | ||||||||
FaxNumber: | 4105544326 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 06/16/2006 | ||||||||
LastUpdateDate: | 03/08/2017 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | D59372 | MD | N |   | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |   | 207XX0004X | D0059372 | MD | Y |   | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Foot and Ankle Surgery |
ID Information
ID | Type | State | Issuer | Description | 896201 | 05 | MD |   | MEDICAID | 61674501 | 01 | MD | BCBS | OTHER | 903A | 01 | MD | CFBCBS MD | OTHER | J848 | 01 | DC | CFBCBS DC | OTHER |