Healthcare Provider Details

I. General information

NPI: 1255328811
Provider Name (Legal Business Name): HAROLD O. GAINES M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2005
Last Update Date: 03/20/2020
Certification Date: 03/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 CHARLES ST
LA PLATA MD
20646-5930
US

IV. Provider business mailing address

3836 EARLY GLOW LN
BOWIE MD
20716-3362
US

V. Phone/Fax

Practice location:
  • Phone: 301-609-4000
  • Fax: 301-609-4410
Mailing address:
  • Phone: 301-352-0980
  • Fax: 301-609-4244

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberD0044230
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberD44230
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: