Provider Demographics
NPI:1255691168
Name:GILL, MANMOHAN K
Entity Type:Individual
Prefix:MS
First Name:MANMOHAN
Middle Name:K
Last Name:GILL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1043 STERLING RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:HERNDON
Mailing Address - State:VA
Mailing Address - Zip Code:20170-3866
Mailing Address - Country:US
Mailing Address - Phone:703-689-0111
Mailing Address - Fax:703-689-0077
Practice Address - Street 1:1043 STERLING RD
Practice Address - Street 2:SUITE 104
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20170-3866
Practice Address - Country:US
Practice Address - Phone:703-689-0111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-24
Last Update Date:2014-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001189983163W00000X
VA0024169989363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse