Provider Demographics
NPI:1629071139
Name:WINNAN, GERALD ROLAND (MD)
Entity Type:Individual
Prefix:DR
First Name:GERALD
Middle Name:ROLAND
Last Name:WINNAN
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 1:6315 WINPENNY DR
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21702-2400
Mailing Address - Country:US
Mailing Address - Phone:301-694-0677
Mailing Address - Fax:
Practice Address - Street 1:310 W NINTH ST
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21701-4546
Practice Address - Country:US
Practice Address - Phone:301-695-6800
Practice Address - Fax:301-695-6891
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-05-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0025151173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173000000XOther Service ProvidersLegal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDB68045Medicare UPIN
MDS399Medicare ID - Type Unspecified