Provider Demographics
NPI:1851396204
Name:GARGOUR, GUY W (MD)
Entity Type:Individual
Prefix:
First Name:GUY
Middle Name:W
Last Name:GARGOUR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:10401 HOSPITAL DR
Mailing Address - Street 2:STE 101
Mailing Address - City:CLINTON
Mailing Address - State:MD
Mailing Address - Zip Code:20735-3150
Mailing Address - Country:US
Mailing Address - Phone:301-856-2323
Mailing Address - Fax:301-856-5619
Practice Address - Street 1:10401 HOSPITAL DR
Practice Address - Street 2:STE 101
Practice Address - City:CLINTON
Practice Address - State:MD
Practice Address - Zip Code:20735-3150
Practice Address - Country:US
Practice Address - Phone:301-856-2323
Practice Address - Fax:301-856-5619
Is Sole Proprietor?:No
Enumeration Date:2005-06-14
Last Update Date:2011-04-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
DCMD4405207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCD09484Medicare UPIN
MD206996ZBRPMedicare PIN
DC174733YT2Medicare PIN