Provider Demographics
NPI:1750714770
Name:GNATT MEDICAL ASSOCIATES, LLC
Entity type:Organization
Organization Name:GNATT MEDICAL ASSOCIATES, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:GNATT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-801-8268
Mailing Address - Street 1:11912 JUBAL EARLY CT
Mailing Address - Street 2:
Mailing Address - City:POTOMAC
Mailing Address - State:MD
Mailing Address - Zip Code:20854-3427
Mailing Address - Country:US
Mailing Address - Phone:301-801-8268
Mailing Address - Fax:
Practice Address - Street 1:15225 SHADY GROVE ROAD
Practice Address - Street 2:SUITE 104
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-3446
Practice Address - Country:US
Practice Address - Phone:301-801-8268
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-13
Last Update Date:2013-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty