Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | 04504 | MD |
Y | 103TC0700X | Clinical Psychologist | 04504 | MD |
NPI | 1013157312 |
---|---|
Provider Name | Dr. Gabriel Eidelman |
First Address | Rockville, MD 20850-2909 |
Second Address | Rockville, MD 20850-4217 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/02/2009 |
Last Update Date | 26/02/2009 |