Active NPI
John S. Gottdiener, M.D.
- Cardiovascular Disease Physician
- Baltimore, MD
National Provider Identifier
1003865494
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Cardiovascular Disease Physician
- License
- D27798
- Practice address
- 22 S Greene St
Baltimore, MD 21201-1544 - Phone
- (410) 328-5196
- Fax
- (410) 328-0248
- NPI assigned
- May 10, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Cardiovascular Disease Physician | 207RC0000X | D27798 | MD | Primary |
Addresses
Primary practice location
22 S Greene St
Baltimore, MD 21201-1544
Mailing address
PO Box 64442
Baltimore, MD 21264-4442
Phone (410) 328-5196
Other identifiers 5
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 208101601 | Medicaid | MD | |
| 354362-01 | Other | MD | BLUE CROSS/BLUE SHIELD |
| 3810001953 | Medicaid | WV | |
| 039499200 | Medicaid | DC | |
| 1003865494 | Medicaid | DE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| D27798 | MD | MD | Cardiovascular Disease Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1147219200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1244073600000",
"number": "1003865494",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 64442",
"city": "BALTIMORE",
"state": "MD",
"postal_code": "212644442",
"telephone_number": "410-328-5196",
"fax_number": "410-328-0248"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "22 S GREENE ST",
"city": "BALTIMORE",
"state": "MD",
"postal_code": "212011544",
"telephone_number": "410-328-5196",
"fax_number": "410-328-0248"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GOTTDIENER",
"first_name": "JOHN",
"middle_name": "S.",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-05-10",
"last_updated": "2009-06-04",
"status": "A"
},
"taxonomies": [
{
"code": "207RC0000X",
"taxonomy_group": "",
"desc": "Internal Medicine, Cardiovascular Disease",
"state": "MD",
"license": "D27798",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "208101601",
"state": "MD"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS/BLUE SHIELD",
"identifier": "354362-01",
"state": "MD"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "3810001953",
"state": "WV"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "039499200",
"state": "DC"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1003865494",
"state": "DE"
}
],
"endpoints": [],
"other_names": []
}Other providers in Baltimore, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 4, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.