Provider Demographics
NPI:1235178344
Name:GENDEL, MIKHAIL (MD)
Entity Type:Individual
Prefix:DR
First Name:MIKHAIL
Middle Name:
Last Name:GENDEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:16220 FREDERICK RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20877-4039
Mailing Address - Country:US
Mailing Address - Phone:301-519-2650
Mailing Address - Fax:301-519-2653
Practice Address - Street 1:16220 FREDERICK RD
Practice Address - Street 2:SUITE 200
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20877-4039
Practice Address - Country:US
Practice Address - Phone:301-519-2650
Practice Address - Fax:301-519-2653
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2011-04-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDDOO52322207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDG01944Medicare UPIN