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General NPI Number Information
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NPI Number | 1710041769
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Entity Type | Individual
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Provider Name | IVAN Z GORELIK MD
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Gender | Male
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Dates
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Enumeration Date | 12/21/2006
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Last Update Date | 12/06/2012
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Provider Practice Location Address
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Address Line | 7141 SECURITY BLVD KAISER PERMANENTE WOODLAWN MEDICAL CENTER
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City | BALTIMORE
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State | MD
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Zip | 21244-1811
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Country | US
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Telephone | 443-663-6000
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Fax |
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Provider Business Mailing Address
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Address Line | 2101 E JEFFERSON ST KAISER PERMANENTE MEDICARE ENROLLMENT
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City | ROCKVILLE
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State | MD
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Zip | 20852-4908
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Country | US
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Telephone | 301-816-2424
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Fax |
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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 | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | D18167
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License Number State | MD
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