Provider Demographics
NPI:1497829592
Name:SIMREL, KERMIT O JR
Entity type:Individual
Prefix:DR
First Name:KERMIT
Middle Name:O
Last Name:SIMREL
Suffix:JR
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 1:2600 NAYLOR RD SE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20020-7256
Mailing Address - Country:US
Mailing Address - Phone:202-582-6822
Mailing Address - Fax:202-584-1665
Practice Address - Street 1:9015 WOODYARD RD
Practice Address - Street 2:SUITE 111
Practice Address - City:CLINTON
Practice Address - State:MD
Practice Address - Zip Code:20735-4209
Practice Address - Country:US
Practice Address - Phone:301-599-0900
Practice Address - Fax:301-599-7828
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2013-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0040023208000000X
DCMD10045208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD185161600Medicaid
DC0115143700Medicaid