Organization
DAVID GANNON DPM LLC
Active
Other names
Shore Foot & Ankle
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DAVID GANNON D.P.M. (PODIATRIST/SOLE OWNER)
(410) 629-0222
Entity
Organization
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
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
01311
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4150953-00
—
MD
01
—
6031730001
DME
—
01
—
DN7994
RAIL ROAD MEDICARE GROUP PTAN
MD
Enumeration date
07/26/2006
Last updated
11/30/2009
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