Individual
JEEVAN GAUTAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
600 S CATON AVE, BALTIMORE, MD 21229-4206
(667) 234-5724
(667) 234-3525
Mailing address
600 S CATON AVE, BALTIMORE, MD 21229-4206
(667) 234-5724
(667) 234-3525
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
06/01/2023
Last updated
06/01/2023
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