Healthcare Provider Details

I. General information

NPI: 1053688804
Provider Name (Legal Business Name): KEITH MARK HULL MD, PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/22/2011
Last Update Date: 03/29/2025
Certification Date: 03/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 METROPOLITAN CT STE 1
GAITHERSBURG MD
20878-4016
US

IV. Provider business mailing address

7 METROPOLITAN CT STE 1
GAITHERSBURG MD
20878-4016
US

V. Phone/Fax

Practice location:
  • Phone: 240-773-0300
  • Fax:
Mailing address:
  • Phone: 240-773-0300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License NumberD0063885
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: