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General NPI Number Information
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NPI Number | 1619973963
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Entity Type | Individual
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Provider Name | ELIZABETH S GANTT MD
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Gender | Female
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Dates
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Enumeration Date | 06/22/2005
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Last Update Date | 03/01/2013
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Provider Practice Location Address
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Address Line | 9420 KEY WEST SUITE 202
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City | ROCKVILLE
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State | MD
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Zip | 20850
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Country | US
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Telephone | 301-251-9555
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Fax | 301-309-0765
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Provider Business Mailing Address
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Address Line | PO BOX 37229
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City | BALTIMORE
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State | MD
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Zip | 21297
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Country | US
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Telephone | 240-485-5200
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Fax | 301-625-6906
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | D41612
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License Number State | MD
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