Healthcare Provider Details

I. General information

NPI: 1235178344
Provider Name (Legal Business Name): MIKHAIL GENDEL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2006
Last Update Date: 04/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16220 FREDERICK RD SUITE 200
GAITHERSBURG MD
20877-4039
US

IV. Provider business mailing address

16220 FREDERICK RD SUITE 200
GAITHERSBURG MD
20877-4039
US

V. Phone/Fax

Practice location:
  • Phone: 301-519-2650
  • Fax: 301-519-2653
Mailing address:
  • Phone: 301-519-2650
  • Fax: 301-519-2653

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberDOO52322
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: