Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RC0000X | Internist - Cardiovascular Disease | D27798 | MD |
NPI | 1003865494 |
---|---|
Provider Name | Dr. John S. Gottdiener |
First Address | Baltimore, MD 21264-4442 |
Second Address | Baltimore, MD 21201-1544 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/05/2006 |
Last Update Date | 04/06/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
039499200 | (05) | DC |
1003865494 | (05) | DE |
208101601 | (05) | MD |
354362-01 | BLUE CROSS/BLUE SHIELD (01) | MD |
3810001953 | (05) | WV |
B67100 | (02) |