1508856915 NPI number — RICHARD H GUNNING MD

Table of content: RICHARD H GUNNING MD (NPI 1508856915)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508856915 NPI number — RICHARD H GUNNING MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GUNNING
Provider First Name:
RICHARD
Provider Middle Name:
H
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1508856915
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/24/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3515 MASSILLON RD STE 300
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
UNIONTOWN
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44685-7854
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
234-271-3353
Provider Business Mailing Address Fax Number:
330-331-7587

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3300 GREENWICH RD UNIT 8
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORTON
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44203-5781
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
330-825-7468
Provider Business Practice Location Address Fax Number:
330-634-1329
Provider Enumeration Date:
10/26/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  35-063883 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 000000489186 . This is a "ANTHEM" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 0924316 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".