Individual
DR. DAVID GANNON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DPM
Contact information
Practice address
9956 N MAIN ST, SUITE #5, BERLIN, MD 21811-1077
(410) 629-0222
(410) 629-0225
Mailing address
9956 N MAIN ST, SUITE #5, BERLIN, MD 21811-1077
(410) 629-0222
(410) 629-0225
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
01311
MD
213E00000X
Podiatrist
E1-0000205
DE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3494004-00
—
MD
01
—
6031730002
DME
DE
01
—
E1-0000205
STATE LICENSE
DE
01
—
P00639639
RAIL ROAD MEDICARE - INDIVIDUAL PTAN
MD
Enumeration date
01/09/2006
Last updated
04/05/2019
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