Healthcare Provider Details

I. General information

NPI: 1306861810
Provider Name (Legal Business Name): TODD DAVID GLEESON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8901 WISCONSIN AVE
BETHESDA MD
20889-0001
US

IV. Provider business mailing address

5020 MONTGOMERY RD
ELLICOTT CITY MD
21043-6719
US

V. Phone/Fax

Practice location:
  • Phone: 301-295-6295
  • Fax: 301-295-2992
Mailing address:
  • Phone: 410-404-9206
  • Fax: 301-295-2992

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number0101234404
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: