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General NPI Number Information
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NPI Number | 1861419715
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Entity Type | Organization
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Legal Business Name | MIKHAIL GENDEL FAMILY PRACTICE, LLC
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Dates
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Enumeration Date | 07/16/2006
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Last Update Date | 11/24/2011
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Provider Practice Location Address
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Address Line | 16220 FREDERICK RD SUITE 200
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City | GAITHERSBURG
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State | MD
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Zip | 20877-4039
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Country | US
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Telephone | 301-519-2650
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Fax | 301-519-2653
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Provider Business Mailing Address
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Address Line | 16220 FREDERICK RD SUITE 200
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City | GAITHERSBURG
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State | MD
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Zip | 20877-4039
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Country | US
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Telephone | 301-519-2650
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Fax | 301-519-2653
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. MIKHAIL GENDEL
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Credential | MD
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Telephone | 301-519-2650
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | DOO52322
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License Number State | MD
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