Healthcare Provider Details

I. General information

NPI: 1295923084
Provider Name (Legal Business Name): ABC CARDIOLOGY CONSULTANTS, HERMAN GIST MD, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2007
Last Update Date: 03/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 IRVING ST NW SUITE 1500 NORTH TOWER
WASHINGTON DC
20010-2927
US

IV. Provider business mailing address

11140 ROCKVILLE PIKE SUITE 100, #335
ROCKVILLE MD
20852-3106
US

V. Phone/Fax

Practice location:
  • Phone: 202-829-2834
  • Fax: 202-882-1274
Mailing address:
  • Phone: 202-829-2834
  • Fax: 202-882-1274

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number20174
License Number StateDC

VIII. Authorized Official

Name: DR. HERMAN GIST
Title or Position: PRESIDENT, OWNER
Credential: M.D.
Phone: 202-829-2834