Provider Demographics
NPI:1568640191
Name:MICHAEL L GITTLESON, DPM
Entity Type:Organization
Organization Name:MICHAEL L GITTLESON, DPM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:LLOYD
Authorized Official - Last Name:GITTLESON
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:301-986-4900
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-06
Last Update Date:2013-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD000918213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
T31032Medicare UPIN
0239920001Medicare NSC