National Provider Identifier
Thomas R. Gustafson, MD
Thomas R. Gustafson, MD is listed in the NPPES registry with a primary specialty of Family Medicine Physician in Pine City, NY and a listed phone number of (607) 734-3929.
Profile Overview
- NPI
- 1720055528
- Provider Type
- Individual
- Primary Specialty
- Family Medicine Physician
- Enumeration Date
- March 01, 2006
- Last Updated
- July 29, 2011
Practice Location
- 1243 Pennsylvania Ave
- Pine City, NY 14871-9230
Phone: (607) 734-3929
Mailing Address
- 1 Guthrie Sq
- Sayre, PA 18840-1625
Specialties
- Family Medicine Physician (207Q00000X)
- Family Medicine Physician (207Q00000X)
Full Record
- NPI
- 1720055528
- Entity Type
- Individual
- Last Name
- Gustafson
- First Name
- Thomas
- Middle Name
- R.
- Name Prefix
- Dr.
- Credential
- MD
- Mailing Street Address
- 1 Guthrie Sq
- Mailing City
- Sayre
- Mailing State
- PA
- Mailing ZIP Code
- 18840-1625
- Mailing Country
- US
- Mailing Phone
- (570) 888-5858
- Practice Street Address
- 1243 Pennsylvania Ave
- Practice City
- Pine City
- Practice State
- NY
- Practice ZIP Code
- 14871-9230
- Practice Country
- US
- Practice Phone
- (607) 734-3929
- Practice Fax
- (607) 734-0781
- Enumeration Date
- March 01, 2006
- Last Updated
- July 29, 2011
- Sex
- Male
- Sole Proprietor
- No
- updated_by_file
- npidata_pfile_20050523-20260308.csv
- Taxonomies
- Family Medicine Physician (207Q00000X), Family Medicine Physician (207Q00000X)
- Other Identifiers
- 0012479510001 (PA), 01255774 (NY), 080173355 (NY, Rr Medicare Pin), CC8362 (NY, Rr Medicare Group)