Provider Demographics
NPI:1811082902
Name:GITTER, JONATHAN (MD)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:
Last Name:GITTER
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 1:8408 PARK HEIGHTS AVE.
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21208
Mailing Address - Country:US
Mailing Address - Phone:443-250-2810
Mailing Address - Fax:
Practice Address - Street 1:341 N CALVERT ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21202-3633
Practice Address - Country:US
Practice Address - Phone:410-986-4400
Practice Address - Fax:410-986-4411
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2009-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0041291207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD099921100Medicaid
MDD0041291OtherSTATE LICENSE NO.
MDD0041291OtherSTATE LICENSE NO.
MD305MMedicare ID - Type Unspecified