Individual
DR. BLAZE ROBERT GUSIC
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
30 MEDICAL CENTER BLVD, SUITE 205, UPLAND, PA 19013-3957
(610) 619-7410
(610) 876-8483
Mailing address
30 MEDICAL CENTER BLVD, SUITE 205, UPLAND, PA 19013-3957
(610) 619-7410
(610) 876-8483
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
12628
NV
208000000X
Pediatrics Physician
Primary
MD-062845-L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001684683
—
PA
Enumeration date
07/20/2006
Last updated
10/15/2012
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