# DAVID GANNON DPM LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Shore Foot & Ankle
- **Organization subpart:** No

## Provider details

- **NPI number:** 1861415200
- **Authorized official:** DR. DAVID GANNON D.P.M. (PODIATRIST/SOLE OWNER)
- **Authorized official phone:** (410) 629-0222

## Contact information

- **Practice address:** 9956 N MAIN ST, SUITE \#5, BERLIN, MD 21811-1077
- **Practice address phone:** (410) 629-0222
- **Practice address fax:** (410) 629-0225
- **Mailing address:** 9956 N MAIN ST, SUITE \#5, BERLIN, MD 21811-1077
- **Mailing address phone:** (410) 629-0222
- **Mailing address fax:** (410) 629-0225

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 213ES0103X | Foot & Ankle Surgery Podiatrist | 01311 | MD | Yes |

## Other

- **Enumeration date:** 07/26/2006
- **Last updated:** 11/30/2009