Provider Demographics
NPI:1669479309
Name:GIL, KEVIN MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:MICHAEL
Last Name:GIL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:361 WINTER WALK DR
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20878-7806
Mailing Address - Country:US
Mailing Address - Phone:301-926-0693
Mailing Address - Fax:
Practice Address - Street 1:14816 PHYSICIANS LN
Practice Address - Street 2:SUITE 253
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-3944
Practice Address - Country:US
Practice Address - Phone:301-610-6313
Practice Address - Fax:301-610-6318
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-07
Last Update Date:2010-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD35192207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
490625Medicare ID - Type Unspecified
E81579Medicare UPIN