Healthcare Provider Details

I. General information

NPI: 1780851741
Provider Name (Legal Business Name): DAVID B GOOTNICK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/09/2008
Last Update Date: 05/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

441 G ST NW 4T31
WASHINGTON DC
20548-0001
US

IV. Provider business mailing address

441 G ST NW 4T31
WASHINGTON DC
20548-0001
US

V. Phone/Fax

Practice location:
  • Phone: 202-512-3149
  • Fax:
Mailing address:
  • Phone: 202-512-3149
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146D00000X
TaxonomyPersonal Emergency Response Attendant
License Number160031-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: