Individual
KAREN SUE GUSTAFSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
800 SPRUCE ST, PHILADELPHIA, PA 19107-6130
(215) 829-3000
(215) 829-7564
Mailing address
800 SPRUCE ST, PHILADELPHIA, PA 19107-6130
(215) 829-3000
(215) 829-7564
Taxonomy
Speciality
Code
Description
License number
State
207ZP0101X
Anatomic Pathology Physician
Primary
MD417830
PA
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
D61910
MD
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
MD417830
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1022745620001
—
PA
05
—
405278100
—
MD
Enumeration date
05/05/2006
Last updated
10/28/2019
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