Healthcare Provider Details

I. General information

NPI: 1780664763
Provider Name (Legal Business Name): SUSAN GAYLOR MD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/18/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 IRVING ST NW
WASHINGTON DC
20010-2976
US

IV. Provider business mailing address

10310 JULEP AVE
SILVER SPRING MD
20902-3862
US

V. Phone/Fax

Practice location:
  • Phone: 202-877-8895
  • Fax:
Mailing address:
  • Phone: 301-649-2648
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN30456
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: