Provider Demographics
NPI:1770655151
Name:RESTREPO, GUSTAVO (MD)
Entity Type:Individual
Prefix:DR
First Name:GUSTAVO
Middle Name:
Last Name:RESTREPO
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 1:8955 EDMONSTON RD
Mailing Address - Street 2:SUITE I
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20770-4036
Mailing Address - Country:US
Mailing Address - Phone:301-441-9410
Mailing Address - Fax:301-345-6671
Practice Address - Street 1:8955 EDMONSTON RD
Practice Address - Street 2:SUITE I
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770-4036
Practice Address - Country:US
Practice Address - Phone:301-441-9410
Practice Address - Fax:301-345-6671
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0008513208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
27150OtherMAMSI MD IPA
0641053007OtherCIGNA
DC08190001OtherBLUE CHOICE
1700201OtherUNITED HEALTH CARE
DC0819OtherCAREFIRST BCBS
30452OtherJOHNE HOPKINS HEALTH CARE
455844OtherUS HEALTHCARE AETNA
VA75676OtherANTHEM
488044OtherNCPPO
MD6985OtherCAREFIRST BCBS
DC0819OtherCARE FIRST BCBS
DC0819OtherCAREFIRST BCBS
455844OtherUS HEALTHCARE AETNA