MEDICARE: TED GERSTENBLITH M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084B0040X	Behavioral Neurology & Neuropsychiatry Physician	249976	MA
2	2084P0800X	Psychiatry Physician	D77895	MD

General Provider Information

NPI Number	:	1174709992
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TED GERSTENBLITH M.D.

Provider Business Mailing Address
First Line	:	9910 FRANKLIN SQUARE DR STE 2110
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21236-4902
Country	:	US
Telephone Number	:	410-933-6423
Fax Number	:

Provider Business Practice Location Address
First Line	:	600 N WOLFE STREET
Second Line	:	MEYER 106
City	:	BALTIMORE
State	:	MD
Zip	:	21287-0005
Country	:	US
Telephone Number	:	410-955-4199
Fax Number	:	410-614-5913

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/10/2008
Last Update Date	:	10/18/2019

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