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:
Health care specialties
| Specialty | Code | License # | 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 13 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1912927138 | NPPES |
| Pennsylvania | MEDICAID | 001684683 |
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