Provider Demographics
NPI:1790762300
Name:GIL-PIRES, ELISA (MD)
Entity Type:Individual
Prefix:
First Name:ELISA
Middle Name:
Last Name:GIL-PIRES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6121 MONTROSE RD
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-4803
Mailing Address - Country:US
Mailing Address - Phone:301-770-8377
Mailing Address - Fax:301-816-7716
Practice Address - Street 1:6121 MONTROSE RD
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-4803
Practice Address - Country:US
Practice Address - Phone:301-770-8377
Practice Address - Fax:301-816-7716
Is Sole Proprietor?:No
Enumeration Date:2005-12-23
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT039874207R00000X, 207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDD0077005OtherMEDICAL LICENSE
MD422842100Medicaid
MDBG8045521OtherDEA
MDD0077005OtherMEDICAL LICENSE
CT380000207Medicare PIN
CT010039874CT01OtherBC/BS
CT001398743Medicaid