Blaze Robert Gusic, M.D.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

MD-062845-L Issued in PA

Practice address

30 Medical Center Blvd
Suite 205
Upland, PA 19013-3957

Phone

(610) 619-7410

Fax

(610) 876-8483

NPI assigned

Jul 20, 2006

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1153353600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1350259200000",
    "number": "1912927138",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30 MEDICAL CENTER BLVD",
            "address_2": "SUITE 205",
            "city": "UPLAND",
            "state": "PA",
            "postal_code": "190133957",
            "telephone_number": "610-619-7410",
            "fax_number": "610-876-8483"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30 MEDICAL CENTER BLVD",
            "address_2": "SUITE 205",
            "city": "UPLAND",
            "state": "PA",
            "postal_code": "190133957",
            "telephone_number": "610-619-7410",
            "fax_number": "610-876-8483"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GUSIC",
        "first_name": "BLAZE",
        "middle_name": "ROBERT",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-20",
        "last_updated": "2012-10-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "PA",
            "license": "MD-062845-L",
            "primary": true
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NV",
            "license": "12628",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001684683",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jeffrey Stephen George, MD
• Frank P Giammattei, MD
• Julia Elizabeth Knaus Godfrey, PA-C
• Elina Golub, NP
• Madhavi Gupta, MD
• Peter John Guzzetti, RPH
• Pamela Muschek Hale, MD
• Geraldine Hamilton, M.D.
• Mark Harris, MD
• Kevin Mason Harrison, CRNA

• Pediatrics Physician in Upland, PA
• Providers in Upland, PA by specialty
• Pediatrics Physician in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.