Individual
LAVERNE D GUGINO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
119 SUMMIT AVE, WINTHROP, MA 02152
(617) 418-0478
Mailing address
3 MARYLAND FARMS STE 200, BRENTWOOD, TN 37027-5005
(615) 345-5400
(888) 468-6603
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
46992
MA
2084N0600X
Clinical Neurophysiology Physician
Primary
46992
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6165362
—
MA
05
—
6166253
—
MA
01
—
J01021
BLUE CROSS BLUE SHIELD
MA
05
—
LG58278
—
RI
Enumeration date
11/22/2005
Last updated
12/20/2018
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