Healthcare Provider Details

I. General information

NPI: 1851398689
Provider Name (Legal Business Name): MITCHELL SENDER GITTELMAN D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 10/03/2023
Certification Date: 10/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31413 WINTERPLACE PKWY STE 103
SALISBURY MD
21804-1877
US

IV. Provider business mailing address

PO BOX 1978
SALISBURY MD
21802-1978
US

V. Phone/Fax

Practice location:
  • Phone: 410-860-0100
  • Fax: 410-860-4894
Mailing address:
  • Phone: 410-749-1015
  • Fax: 410-749-0654

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberH0054827
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: