Provider Demographics
NPI:1114228137
Name:GERSHENGORN, MARVIN C (MD)
Entity Type:Individual
Prefix:DR
First Name:MARVIN
Middle Name:C
Last Name:GERSHENGORN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 S DRIVE MSC 8029
Mailing Address - Street 2:BLDG 50, ROOM 4134
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20892-0001
Mailing Address - Country:US
Mailing Address - Phone:301-451-6305
Mailing Address - Fax:301-480-4212
Practice Address - Street 1:50 S DRIVE MSC 8029
Practice Address - Street 2:BLDG 50, ROOM 4134
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20892-0001
Practice Address - Country:US
Practice Address - Phone:301-451-6305
Practice Address - Fax:301-480-4212
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-08
Last Update Date:2010-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY115854207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism