Healthcare Provider Details

I. General information

NPI: 1831549757
Provider Name (Legal Business Name): GILEAD MEDICAL ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2016
Last Update Date: 04/16/2024
Certification Date: 04/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1818 NEW YORK AVE NE STE 213
WASHINGTON DC
20002-1849
US

IV. Provider business mailing address

9470 ANNAPOLIS RD SUITE 117
LANHAM MD
20706-3025
US

V. Phone/Fax

Practice location:
  • Phone: 301-577-9111
  • Fax: 301-577-9199
Mailing address:
  • Phone: 301-577-9111
  • Fax: 301-577-9199

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License NumberDOO64126
License Number StateMD

VIII. Authorized Official

Name: DR. THEODORE CHINATU OSUALA
Title or Position: PRESIDENT
Credential: MD
Phone: 301-237-0897