Basic Information
| Provider Information | |||||||||
| NPI: | 1770659799 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GURAK | ||||||||
| FirstName: | RANDALL | ||||||||
| MiddleName: | BRUCE | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 341 | ||||||||
| Address2: | |||||||||
| City: | VALLEY FORGE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 194810341 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6106404751 | ||||||||
| FaxNumber: | 6109337451 | ||||||||
| Practice Location | |||||||||
| Address1: | 1604 HORSESHOE TRAIL | ||||||||
| Address2: | RM 341 | ||||||||
| City: | VALLEY FORGE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 19481 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6106404751 | ||||||||
| FaxNumber: | 6109337451 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/28/2006 | ||||||||
| LastUpdateDate: | 02/21/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 02/09/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0804X | MD039270E | PA | N | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Child & Adolescent Psychiatry | 2084P0804X | 25MA05031100 | NJ | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Child & Adolescent Psychiatry |
No ID Information.