Provider Demographics
NPI:1255328811
Name:GAINES, HAROLD O (MD)
Entity Type:Individual
Prefix:DR
First Name:HAROLD
Middle Name:O
Last Name:GAINES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:3836 EARLY GLOW LN
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20716-3362
Mailing Address - Country:US
Mailing Address - Phone:301-352-0980
Mailing Address - Fax:301-609-4244
Practice Address - Street 1:701 CHARLES ST
Practice Address - Street 2:
Practice Address - City:LA PLATA
Practice Address - State:MD
Practice Address - Zip Code:20646-5930
Practice Address - Country:US
Practice Address - Phone:301-609-4000
Practice Address - Fax:301-609-4410
Is Sole Proprietor?:No
Enumeration Date:2005-09-29
Last Update Date:2020-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0044230174400000X
MDD44230207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDF57394Medicare UPIN