Gustavson, Roger B.

Gustavson, Roger B. is an individual health care provider with primary practice located at 890 Poplar Church Rd Suite 508, Camp Hill PA 17011-2250. He recently has only one registered license in Allopathic & Osteopathic Physicians / Internal Medicine, which is considered as his primary health care specialty. Gustavson, Roger B. can be contacted via phone (717) 761-3875.

Contact Information

Primary practice address
890 Poplar Church Rd Suite 508 Camp Hill PA 17011-2250
Phone: (717) 761-3875
Fax: (717) 761-7893
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Internal Medicine 207R00000X 012082E Pennsylvania

Profile Details

NPI number 1497745210
LBN Legal business name Gustavson, Roger B.
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Oct 24th, 2005
Last updated Oct 19th, 2007 - about 19 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 1497745210 NPPES
Pennsylvania MEDICAID 0006517640001

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