Provider Demographics
NPI:1164404125
Name:GASTROINTESTINAL ASSOCIATES OF MARYLAND PA
Entity Type:Organization
Organization Name:GASTROINTESTINAL ASSOCIATES OF MARYLAND PA
Other - Org Name:GI ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LEGINA
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:GRAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-645-8035
Mailing Address - Street 1:3510 OLD WASHINGTON RD STE 201
Mailing Address - Street 2:
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20602-3235
Mailing Address - Country:US
Mailing Address - Phone:301-645-8035
Mailing Address - Fax:301-645-5229
Practice Address - Street 1:3510 OLD WASHINGTON RD STE 201
Practice Address - Street 2:
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20602-3235
Practice Address - Country:US
Practice Address - Phone:301-645-8035
Practice Address - Fax:301-645-5229
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-16
Last Update Date:2018-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC035197200Medicaid
MD155700900Medicaid
DC524722Medicare PIN
MD155700900Medicaid