Healthcare Provider Details

I. General information

NPI: 1548380223
Provider Name (Legal Business Name): DR. ROBERT M GUM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/29/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2480 LLEWELLYN AVE
FORT GEORGE G MEADE MD
20755-5800
US

IV. Provider business mailing address

2480 LLEWELLYN AVE
FORT GEORGE G MEADE MD
20755-5800
US

V. Phone/Fax

Practice location:
  • Phone: 301-677-8270
  • Fax: 301-677-8176
Mailing address:
  • Phone: 301-677-8270
  • Fax: 301-677-8176

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number990
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: