{
"Npi": {
"NPI": "1861415200",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "DAVID GANNON DPM LLC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": "6",
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "9956 N MAIN ST",
"SecondLineMailingAddress": "SUITE #5",
"MailingAddressCityName": "BERLIN",
"MailingAddressStateName": "MD",
"MailingAddressPostalCode": "21811-1077",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "410-629-0222",
"MailingAddressFaxNumber": "410-629-0225",
"FirstLinePracticeLocationAddress": "9956 N MAIN ST",
"SecondLinePracticeLocationAddress": "SUITE #5",
"PracticeLocationAddressCityName": "BERLIN",
"PracticeLocationAddressStateName": "MD",
"PracticeLocationAddressPostalCode": "21811-1077",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "410-629-0222",
"PracticeLocationAddressFaxNumber": "410-629-0225",
"EnumerationDate": "07/26/2006",
"LastUpdateDate": "11/30/2009",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "GANNON",
"AuthorizedOfficialFirstName": "DAVID",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "PODIATRIST/SOLE OWNER",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "D.P.M.",
"AuthorizedOfficialTelephoneNumber": "410-629-0222",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "213ES0103X",
"TaxonomyName": "Foot & Ankle Surgery Podiatrist",
"LicenseNumber": "01311",
"LicenseNumberStateCode": "MD",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}