Healthcare Provider Details

I. General information

NPI: 1629071139
Provider Name (Legal Business Name): GERALD ROLAND WINNAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/30/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 W NINTH ST
FREDERICK MD
21701-4546
US

IV. Provider business mailing address

6315 WINPENNY DR
FREDERICK MD
21702-2400
US

V. Phone/Fax

Practice location:
  • Phone: 301-695-6800
  • Fax: 301-695-6891
Mailing address:
  • Phone: 301-694-0677
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License NumberD0025151
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: