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NPI Code Detail

MEDICARE: LARRY I. GILTMAN M.D.

MEDICARE: LARRY I. GILTMAN M.D.
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
1207ZP0102XAnatomic Pathology & Clinical Pathology Physician037812GA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1037812OTHERGAMEDICAL LICENSE

General Provider Information

NPI Number : 1700844412
Entity Type Code : Individual
Provider Name (Legal Business Name) : LARRY I. GILTMAN M.D.
Provider Business Mailing Address
First Line : 1670 CLAIRMONT RD
Second Line : VA MEDICAL CENTER, RM 2B294
City : DECATUR
State : GA
Zip : 30033-4004
Country : US
Telephone Number : 404-321-6111
Fax Number : 404-235-3007
Provider Business Practice Location Address
First Line : 1670 CLAIRMONT RD
Second Line : VA MEDICAL CENTER, RM 2B294
City : DECATUR
State : GA
Zip : 30033-4004
Country : US
Telephone Number : 404-321-6111
Fax Number : 404-235-3007
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/02/2006
Last Update Date : 07/08/2007

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