Provider Demographics
NPI:1003908179
Name:GITTLESON, MICHAEL LLOYD (DPM)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:LLOYD
Last Name:GITTLESON
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5454 WISCONSIN AVE
Mailing Address - Street 2:#1250
Mailing Address - City:CHEVY CHASE
Mailing Address - State:MD
Mailing Address - Zip Code:20815
Mailing Address - Country:US
Mailing Address - Phone:301-986-4900
Mailing Address - Fax:301-986-0002
Practice Address - Street 1:5454 WISCONSIN AVE
Practice Address - Street 2:#1250
Practice Address - City:CHEVY CHASE
Practice Address - State:MD
Practice Address - Zip Code:20815
Practice Address - Country:US
Practice Address - Phone:301-986-4900
Practice Address - Fax:301-986-0002
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2013-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD000918213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD02399200-01OtherDME
T31032Medicare UPIN
MD02399200-01OtherDME