Healthcare Provider Details

I. General information

NPI: 1881038107
Provider Name (Legal Business Name): GREGORY CONSTANTINE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2013
Last Update Date: 07/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 CENTER DRIVE
BETHESDA MD
20814
US

IV. Provider business mailing address

BUILDING 10, 10 CENTER DRIVE, ROOM # 11C112 MAIL STOP 1880
BETHESDA MD
20814
US

V. Phone/Fax

Practice location:
  • Phone: 301-761-7966
  • Fax:
Mailing address:
  • Phone: 301-761-7966
  • Fax: 216-750-3800

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RA0201X
TaxonomyAllergy & Immunology (Internal Medicine) Physician
License NumberMD045198
License Number StateDC
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberBP10046658
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: