Gusic, Blaze Robert

Gusic, Blaze Robert is an sole proprietor health care provider with primary practice located at 30 Medical Center Blvd Suite 205, Upland PA 19013-3957. He recently has only one registered license in Allopathic & Osteopathic Physicians / Pediatrics, which is considered as his primary health care specialty. Gusic, Blaze Robert can be contacted via phone (610) 619-7410.

Contact Information

Primary practice address
30 Medical Center Blvd Suite 205 Upland PA 19013-3957
Phone: (610) 619-7410
Fax: (610) 876-8483
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Pediatrics 208000000X MD-062845-L Pennsylvania
Allopathic & Osteopathic Physicians / Pediatrics 208000000X 12628 Nevada

Profile Details

NPI number 1912927138
LBN Legal business name Gusic, Blaze Robert
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Jul 20th, 2006
Last updated Oct 15th, 2012 - about 14 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1912927138 NPPES
Pennsylvania MEDICAID 001684683

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