Dr. Mark Gustafson
Gynecologist
1802 Braeburn Dr
Salem
, Virginia 24153-7357
Dr. Mark Gustafson
Gynecologist
1802 Braeburn Dr
Salem
, Virginia 24153-7357
(540) 772-5975
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About
Features
Specialties
- Gynecologist
Languages spoken
- English
Location
First Address
- Dr. Mark Gustafson
- 1802 Braeburn Dr
- Salem, VA
- Zip : 24153-7357
- Fax : (540) 772-5975
- Phone : (540) 772-3520
Second Address
- Dr. Mark Gustafson
- 1802 Braeburn Dr
- Salem, VA
- Zip : 24153-7357
- Fax : (540) 772-5975
- Phone : (540) 772-3520
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 207VG0400X | Gynecologist | 0101038915 | VA |
National Provider Identifier
| NPI | 1134108756 |
|---|---|
| Provider Name | Dr. Mark Gustafson |
| First Address | Salem, VA 24153-7357 |
| Second Address | Salem, VA 24153-7357 |
| Gender | M |
| NPI Entity type | Individual |
| Is Sole Proprietor | No |
| Is Organization Subpart | N/A |
| Enumeration Date | 12/01/2006 |
| Last Update Date | 28/11/2007 |
Additional Identifiers
| IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
|---|---|---|
| B06460 | (02) | |
| P00276916 | MEDICARE RAILROAD (01) | VA |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.