MEDICARE: MICHAEL GIBBONS MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2083P0901X	Public Health & General Preventive Medicine Physician	D0106199	MD

General Provider Information

NPI Number	:	1164378196
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL GIBBONS MD

Provider Business Mailing Address
First Line	:	8843 GREENBELT RD # 103
Second Line	:
City	:	GREENBELT
State	:	MD
Zip	:	20770-2451
Country	:	US
Telephone Number	:	240-350-4490
Fax Number	:

Provider Business Practice Location Address
First Line	:	11312 WYCOMBE PARK LN
Second Line	:
City	:	GLENN DALE
State	:	MD
Zip	:	20769-2029
Country	:	US
Telephone Number	:	240-350-4490
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/10/2026
Last Update Date	:	03/10/2026

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