=====================================================
General NPI Number Information
=====================================================
NPI Number | 1013258060
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | XLHOME, P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/14/2013
-----------------------------------------------------
Last Update Date | 03/26/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1633 WESTLAKE AVE N STE 105
-----------------------------------------------------
City | SEATTLE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98109-6241
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 443-838-6441
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 351 W CAMDEN ST SUITE 100
-----------------------------------------------------
City | BALTIMORE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21201-7912
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-625-2200
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. SIDNEY O. GOTTLIEB
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 416-219-0354
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------