Provider Demographics
NPI:1275519027
Name:MARSTON, GAIL LYNN (MD)
Entity Type:Individual
Prefix:
First Name:GAIL
Middle Name:LYNN
Last Name:MARSTON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6137 NEST SIDE
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21045-4018
Mailing Address - Country:US
Mailing Address - Phone:301-596-6401
Mailing Address - Fax:
Practice Address - Street 1:KIMBROUGH AMBULATORY CARE CENTER
Practice Address - Street 2:LLEWELYN
Practice Address - City:FT MEADE
Practice Address - State:MD
Practice Address - Zip Code:20755
Practice Address - Country:US
Practice Address - Phone:301-677-8716
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD23604208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics