Provider Demographics
NPI:1407056336
Name:GERALD FAMILY CARE
Entity Type:Organization
Organization Name:GERALD FAMILY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:STEWART
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-773-3752
Mailing Address - Street 1:PO BOX 75492
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21275-5492
Mailing Address - Country:US
Mailing Address - Phone:301-773-3752
Mailing Address - Fax:202-529-5290
Practice Address - Street 1:1160 VARNUM ST NE
Practice Address - Street 2:STE 117
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20017-2107
Practice Address - Country:US
Practice Address - Phone:202-832-7007
Practice Address - Fax:202-529-5290
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-19
Last Update Date:2007-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC8702OtherBCBS
DC409561Medicare PIN