Provider Demographics
NPI:1003949348
Name:GOSNELL, MARK STEVEN (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:STEVEN
Last Name:GOSNELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6781 NORRIS LN
Mailing Address - Street 2:
Mailing Address - City:ELKRIDGE
Mailing Address - State:MD
Mailing Address - Zip Code:21075-5727
Mailing Address - Country:US
Mailing Address - Phone:410-294-0715
Mailing Address - Fax:410-902-8247
Practice Address - Street 1:6781 NORRIS LN
Practice Address - Street 2:
Practice Address - City:ELKRIDGE
Practice Address - State:MD
Practice Address - Zip Code:21075-5727
Practice Address - Country:US
Practice Address - Phone:410-294-0715
Practice Address - Fax:410-902-8247
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2022-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00058082207RC0200X
MDD0058082207RS0012X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDE5540029OtherBLUE CHOICE
2110946OtherUNITED
MD61984601OtherBC BS MARYLAND
2110946OtherUNITED
MD61984601OtherBC BS MARYLAND