Healthcare Provider Details

I. General information

NPI: 1699716951
Provider Name (Legal Business Name): JOHN GILBERT P.A.-C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2006
Last Update Date: 07/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8118 GOOD LUCK RD
LANHAM MD
20706-3595
US

IV. Provider business mailing address

8118 GOOD LUCK RD
LANHAM MD
20706-3574
US

V. Phone/Fax

Practice location:
  • Phone: 301-552-8865
  • Fax: 301-552-8172
Mailing address:
  • Phone: 301-552-8865
  • Fax: 301-552-8172

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberC0001790
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: