Healthcare Provider Details

I. General information

NPI: 1780847400
Provider Name (Legal Business Name): MICAH GIROTTI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/02/2008
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 UPPER CHESAPEAKE DR STE 306
BEL AIR MD
21014-4375
US

IV. Provider business mailing address

520 UPPER CHESAPEAKE DRIVE SUITE 306
BEL AIR MD
21014
US

V. Phone/Fax

Practice location:
  • Phone: 410-879-2006
  • Fax: 410-420-4014
Mailing address:
  • Phone: 410-879-2006
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number4301091950
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberD82992
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: