Provider Demographics
NPI:1275528234
Name:GIST, HERMAN (MD)
Entity Type:Individual
Prefix:
First Name:HERMAN
Middle Name:
Last Name:GIST
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:11140 ROCKVILLE PIKE
Mailing Address - Street 2:SUITE 100, #335
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-3106
Mailing Address - Country:US
Mailing Address - Phone:202-557-4046
Mailing Address - Fax:202-882-1274
Practice Address - Street 1:106 IRVING ST NW
Practice Address - Street 2:SUITE 1500 NORTH TOWER
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20010-2927
Practice Address - Country:US
Practice Address - Phone:202-829-2834
Practice Address - Fax:202-882-1274
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-15
Last Update Date:2011-03-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
DCMD20174207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC022484200Medicaid
DCG02672A01Medicare PIN
MDG02672A01Medicare PIN
DCD93210Medicare UPIN