Provider Demographics
NPI:1558098194
Name:GILEAD MEDICAL ASSOCIATES LLC
Entity Type:Organization
Organization Name:GILEAD MEDICAL ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:THEODORE
Authorized Official - Middle Name:C
Authorized Official - Last Name:OSUALA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-577-9111
Mailing Address - Street 1:9470 ANNAPOLIS RD STE 117
Mailing Address - Street 2:
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-3031
Mailing Address - Country:US
Mailing Address - Phone:301-577-9111
Mailing Address - Fax:301-577-9199
Practice Address - Street 1:9470 ANNAPOLIS RD STE 117
Practice Address - Street 2:
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-3031
Practice Address - Country:US
Practice Address - Phone:301-577-9111
Practice Address - Fax:301-577-9199
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-03
Last Update Date:2022-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDNONEMedicaid