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General NPI Number Information
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NPI Number | 1710102629
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Entity Type | Organization
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Legal Business Name | MARK O GLADSTEIN MD PLLC
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Dates
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Enumeration Date | 04/16/2007
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Last Update Date | 12/23/2009
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Provider Practice Location Address
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Address Line | 250 E LIBERTY ST SUITE 1005
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City | LOUISVILLE
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State | KY
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Zip | 40202-1538
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Country | US
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Telephone | 502-589-4448
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Fax | 502-589-1209
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Provider Business Mailing Address
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Address Line | 250 E LIBERTY ST SUITE 1005
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City | LOUISVILLE
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State | KY
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Zip | 40202-1538
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Country | US
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Telephone | 502-589-4448
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Fax | 502-589-1209
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. MARK O GLADSTEIN
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Credential | M.D.
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Telephone | 502-589-4448
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number |
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License Number State |
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