Provider Demographics
NPI:1598869885
Name:GAO, ZHEN-YA (MD)
Entity Type:Individual
Prefix:
First Name:ZHEN-YA
Middle Name:
Last Name:GAO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4701 RANDOLPH ROAD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-2260
Mailing Address - Country:US
Mailing Address - Phone:301-816-8933
Mailing Address - Fax:301-816-8934
Practice Address - Street 1:4701 RANDOLPH ROAD
Practice Address - Street 2:SUITE 103
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-2260
Practice Address - Country:US
Practice Address - Phone:301-816-8933
Practice Address - Fax:301-816-8934
Is Sole Proprietor?:No
Enumeration Date:2006-09-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD53544207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
490118Medicare ID - Type Unspecified
G73270Medicare UPIN