MEDICARE: DR. JEFFREY M GITELMAN D.D.S.

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	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	2822	DC

General Provider Information

NPI Number	:	1629056361
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEFFREY M GITELMAN D.D.S.

Provider Business Mailing Address
First Line	:	1234 19TH ST NW
Second Line	:	SUITE 508
City	:	WASHINGTON
State	:	DC
Zip	:	20036-2407
Country	:	US
Telephone Number	:	202-223-3391
Fax Number	:	202-833-8874

Provider Business Practice Location Address
First Line	:	1234 19TH ST NW
Second Line	:	508
City	:	WASHINGTON
State	:	DC
Zip	:	20036-2407
Country	:	US
Telephone Number	:	202-223-3391
Fax Number	:	202-833-8874

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

Provider Enumeration Date	:	01/04/2006
Last Update Date	:	09/11/2008

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