Healthcare Provider Details

I. General information

NPI: 1780896183
Provider Name (Legal Business Name): JIE GAO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2007
Last Update Date: 10/17/2023
Certification Date: 10/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

97 THOMAS JOHNSON DR STE 101
FREDERICK MD
21702-4379
US

IV. Provider business mailing address

8110 MAPLE LAWN BLVD STE 235
FULTON MD
20759-2694
US

V. Phone/Fax

Practice location:
  • Phone: 301-663-4545
  • Fax: 301-663-1709
Mailing address:
  • Phone: 13-408-3393
  • Fax: 301-340-9027

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberD67663
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: