Healthcare Provider Details

I. General information

NPI: 1124207527
Provider Name (Legal Business Name): MARCUS LEON GANN JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/01/2007
Last Update Date: 08/29/2026
Certification Date: 08/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8001 WOODMONT AVE APT 817
BETHESDA MD
20814-3776
US

IV. Provider business mailing address

8001 WOODMONT AVE APT 817
BETHESDA MD
20814-3776
US

V. Phone/Fax

Practice location:
  • Phone: 310-900-5669
  • Fax:
Mailing address:
  • Phone: 410-900-5669
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberD0108068
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: