Healthcare Provider Details

I. General information

NPI: 1407056336
Provider Name (Legal Business Name): GERALD FAMILY CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2007
Last Update Date: 12/11/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1160 VARNUM ST NE STE 117
WASHINGTON DC
20017-2107
US

IV. Provider business mailing address

PO BOX 75492
BALTIMORE MD
21275-5492
US

V. Phone/Fax

Practice location:
  • Phone: 202-832-7007
  • Fax: 202-529-5290
Mailing address:
  • Phone: 301-773-3752
  • Fax: 202-529-5290

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: KIMBERLY STEWART
Title or Position: BILLING MANAGER
Credential:
Phone: 301-773-3752