MEDICARE: DR. NEIL S GLADSTONE MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207VG0400X	Gynecology Physician	016917	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1073697801
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NEIL S GLADSTONE MD

Provider Business Mailing Address
First Line	:	PO BOX 962380
Second Line	:
City	:	RIVERDALE
State	:	GA
Zip	:	30296-6921
Country	:	US
Telephone Number	:	770-996-1200
Fax Number	:	770-907-7492

Provider Business Practice Location Address
First Line	:	81 UPPER RIVERDALE RD
Second Line	:	SUITE 210
City	:	RIVERDALE
State	:	GA
Zip	:	30274-2627
Country	:	US
Telephone Number	:	770-996-1200
Fax Number	:	770-907-7492

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/25/2006
Last Update Date	:	09/05/2013

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