Healthcare Provider Details

I. General information

NPI: 1417001462
Provider Name (Legal Business Name): SANDER GARY GENSER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 03/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8905 WANDERING TRAIL DR
POTOMAC MD
20854-2379
US

IV. Provider business mailing address

8905 WANDERING TRAIL DR
POTOMAC MD
20854-2379
US

V. Phone/Fax

Practice location:
  • Phone: 301-369-1340
  • Fax: 301-340-7247
Mailing address:
  • Phone: 301-369-1340
  • Fax: 301-369-1340

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberD0017860
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License NumberD0017860
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: