Provider Demographics
NPI:1164780342
Name:GITMAN, LYUBA (MD)
Entity Type:Individual
Prefix:
First Name:LYUBA
Middle Name:
Last Name:GITMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 MICHIGAN AVENUE
Mailing Address - Street 2:SUITE 3 WEST 800
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20010-2970
Mailing Address - Country:US
Mailing Address - Phone:202-476-3659
Mailing Address - Fax:202-476-5038
Practice Address - Street 1:111 MICHIGAN AVENUE
Practice Address - Street 2:SUITE 800 (3 WEST)
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20010-2970
Practice Address - Country:US
Practice Address - Phone:202-476-3659
Practice Address - Fax:202-476-5038
Is Sole Proprietor?:No
Enumeration Date:2012-04-25
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
DCMD045037207YP0228X, 207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No207YP0228XAllopathic & Osteopathic PhysiciansOtolaryngologyPediatric Otolaryngology