Provider Demographics
NPI:1134157316
Name:BENDER, GREGORY
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:
Last Name:BENDER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4110 ASPEN HILL RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20853-2853
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3801 INTERNATIONAL DR
Practice Address - Street 2:SUIE 103
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20906-1550
Practice Address - Country:US
Practice Address - Phone:301-598-0123
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2021-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00533972085R0202X
NY2700902085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA007235046Medicaid
VA010075360Medicaid
MD038102100Medicaid
VA010049865Medicaid
VA007200269Medicaid
VA010075483Medicaid
VA007200480Medicaid
VA0100745459Medicaid
VA010075475Medicaid
DC017179600Medicaid
VA007235046Medicaid
VA010049865Medicaid
300138173Medicare PIN
004484C10Medicare ID - Type UnspecifiedCOMMUNITY RADIOLOGY ASSOC
VA0100745459Medicaid
H07108Medicare UPIN
VA007200978Medicare ID - Type UnspecifiedMONTGOMERY COMMUNITY MAGN
VA007200480Medicaid