Provider Demographics
NPI:1851398689
Name:GITTELMAN, MITCHELL SENDER (DO)
Entity Type:Individual
Prefix:DR
First Name:MITCHELL
Middle Name:SENDER
Last Name:GITTELMAN
Suffix:
Gender:M
Credentials:DO
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 1978
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21802-1978
Mailing Address - Country:US
Mailing Address - Phone:410-749-1015
Mailing Address - Fax:410-749-0654
Practice Address - Street 1:31413 WINTERPLACE PKWY STE 103
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21804-1877
Practice Address - Country:US
Practice Address - Phone:410-860-0100
Practice Address - Fax:410-860-4894
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDH0054827207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD119591300Medicaid
H04398Medicare UPIN
MD368280300Medicaid