Healthcare Provider Details

I. General information

NPI: 1073620928
Provider Name (Legal Business Name): CAROL ANN GANDEE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6900 GEORGIA AVE NW
WASHINGTON DC
20307-0003
US

IV. Provider business mailing address

3803 37TH ST
MOUNT RAINIER MD
20712-2112
US

V. Phone/Fax

Practice location:
  • Phone: 202-782-6573
  • Fax: 202-782-6845
Mailing address:
  • Phone: 301-277-6377
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberC01597
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: