Individual
DR. MARK GUSTAFSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1802 BRAEBURN DR, SALEM, VA 24153-7357
(540) 772-3520
(540) 772-5975
Mailing address
1802 BRAEBURN DR, SALEM, VA 24153-7357
(540) 772-3520
(540) 772-5975
Taxonomy
Speciality
Code
Description
License number
State
207VG0400X
Gynecology Physician
Primary
0101038915
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P00276916
MEDICARE RAILROAD
VA
Enumeration date
01/12/2006
Last updated
11/28/2007
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