Provider Demographics
NPI:1528043049
Name:GORBATY, ELLIOTT (MD)
Entity Type:Individual
Prefix:DR
First Name:ELLIOTT
Middle Name:
Last Name:GORBATY
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 1:1411 MADISON PARK DR
Mailing Address - Street 2:SUITE 2B
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21061-6185
Mailing Address - Country:US
Mailing Address - Phone:410-553-9571
Mailing Address - Fax:410-553-9573
Practice Address - Street 1:1411 MADISON PARK DR
Practice Address - Street 2:SUITE 2B
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-6188
Practice Address - Country:US
Practice Address - Phone:410-553-9571
Practice Address - Fax:410-553-9573
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-07
Last Update Date:2009-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0020094207R00000X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD783051300Medicaid
MDB69493Medicare UPIN
MD409111621Medicare PIN
MD783051300Medicaid