Provider Demographics
NPI:1710033022
Name:GAMBRILL, JOHN JR (MD)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:
Last Name:GAMBRILL
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:715 MAIDEN CHOICE LN
Mailing Address - Street 2:
Mailing Address - City:CATONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-5999
Mailing Address - Country:US
Mailing Address - Phone:410-247-5602
Mailing Address - Fax:410-242-1756
Practice Address - Street 1:715 MAIDEN CHOICE LN
Practice Address - Street 2:
Practice Address - City:CATONSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21228-5999
Practice Address - Country:US
Practice Address - Phone:410-247-5602
Practice Address - Fax:410-242-1756
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-27
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD15995207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD200591360Medicaid
MD200591360Medicaid
MDB70143Medicare UPIN
MDC843Medicare PIN