Individual
JACK GLADSTEIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
22 S GREENE ST, BALTIMORE, MD 21201-1544
(410) 328-6749
(410) 328-6136
Mailing address
PO BOX 62063, BALTIMORE, MD 21264-2063
(410) 706-5181
(410) 706-5103
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
D34944
MD
2080A0000X
Pediatric Adolescent Medicine Physician
D34944
MD
2084N0402X
Neurology with Special Qualifications in Child Neurology Physician
Primary
D34944
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
479431100
—
MD
Enumeration date
07/27/2006
Last updated
03/02/2017
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