Provider Demographics
NPI:1689780579
Name:MCGIBBON, KAREN E (MD)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:E
Last Name:MCGIBBON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9440 PENNSYLVANIA AVENUE
Mailing Address - Street 2:#160
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20772-3687
Mailing Address - Country:US
Mailing Address - Phone:301-599-0460
Mailing Address - Fax:301-599-0463
Practice Address - Street 1:3028 BRIGHTSEAT ROAD
Practice Address - Street 2:#104
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706
Practice Address - Country:US
Practice Address - Phone:301-772-6905
Practice Address - Fax:301-772-6908
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MDD0052176207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD409673800Medicaid
MD409673800Medicaid