Provider Demographics
NPI:1134160260
Name:ANDERSON, GAIL J (MD)
Entity type:Individual
Prefix:DR
First Name:GAIL
Middle Name:J
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:4000 MITCHELLVILLE RD
Mailing Address - Street 2:A414
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20716-3104
Mailing Address - Country:US
Mailing Address - Phone:301-860-0985
Mailing Address - Fax:301-860-0978
Practice Address - Street 1:4000 MITCHELLVILLE RD
Practice Address - Street 2:SUITE A414
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20716-3104
Practice Address - Country:US
Practice Address - Phone:301-860-0985
Practice Address - Fax:301-860-0978
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-09
Last Update Date:2010-07-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MDD0053914207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD522342110OtherTAX ID
MD00A696G22Medicare PIN
MDC30222Medicare UPIN