Provider Demographics
NPI:1588626600
Name:PLOTNICK, GARY DAVID (MD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:DAVID
Last Name:PLOTNICK
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:PO BOX 64442
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21264-4442
Mailing Address - Country:US
Mailing Address - Phone:410-328-4394
Mailing Address - Fax:410-328-3530
Practice Address - Street 1:22 S GREENE ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-1544
Practice Address - Country:US
Practice Address - Phone:410-328-4394
Practice Address - Fax:410-328-3530
Is Sole Proprietor?:No
Enumeration Date:2006-04-04
Last Update Date:2010-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD09459207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC034325600Medicaid
MD394791200Medicaid
MD419301-01OtherBLUE CROSS/BLUE SHIELD
NJ8509808Medicaid
DE1588626600Medicaid
VA5841119Medicaid
WV0182597000Medicaid
DE1588626600Medicaid
MD419301-01OtherBLUE CROSS/BLUE SHIELD
VA5841119Medicaid