Healthcare Provider Details

I. General information

NPI: 1063428233
Provider Name (Legal Business Name): JEFFREY GAMBEL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 01/08/2022
Certification Date: 01/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 TWIN SPRINGS RD
HALETHORPE MD
21227-3553
US

IV. Provider business mailing address

5234 LIGHTFOOT PATH
COLUMBIA MD
21044-1102
US

V. Phone/Fax

Practice location:
  • Phone: 410-737-5360
  • Fax: 410-737-5361
Mailing address:
  • Phone: 410-884-1383
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberD0040704
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License NumberD0040704
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License NumberD0040704
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: