| |
9956 N Main St, Suite #5, Berlin, MD 21811-1077 | |
(410) 629-0222 | |
(410) 629-0225 |
Full Name | |
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Type | Facility |
Speciality | Podiatrist - Foot & Ankle Surgery |
Location | 9956 N Main St, Berlin, Maryland |
Accepts Medicare Assignments | Medicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1861415200 | NPI | - | NPPES |
4150953-00 | Medicaid | MD | |
DN7994 | Other | MD | RAIL ROAD MEDICARE GROUP PTAN |
6031730001 | Other | DME |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
213ES0103X | Podiatrist - Foot & Ankle Surgery | 01311 (Maryland) | Primary |
Provider Name | David Gannon |
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Provider Type | Practitioner - Podiatry |
Provider Identifiers | NPI Number: 1376521492 PECOS PAC ID: 9931296175 Enrollment ID: I20071105000083 |
Mailing Address | Practice Location Address |
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9956 N Main St, Suite #5, Berlin, MD 21811-1077 Ph: (410) 629-0222 | 9956 N Main St, Suite #5, Berlin, MD 21811-1077 Ph: (410) 629-0222 |
Dr. David Gannon, DPM Podiatrist Medicare: Accepting Medicare Assignments Practice Location: 9956 N Main St, Suite #5, Berlin, MD 21811 Phone: 410-629-0222 Fax: 410-629-0225 |