Provider Demographics
NPI:1982049193
Name:GI ASSOCIATES OF MARYLAND
Entity Type:Organization
Organization Name:GI ASSOCIATES OF MARYLAND
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LEGINA
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:GRAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-645-8035
Mailing Address - Street 1:3510 OLD WASHINGTON RD STE 201
Mailing Address - Street 2:
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20602-3235
Mailing Address - Country:US
Mailing Address - Phone:301-645-8035
Mailing Address - Fax:301-645-5229
Practice Address - Street 1:101 CENTENNIAL ST
Practice Address - Street 2:SUITE B
Practice Address - City:LA PLATA
Practice Address - State:MD
Practice Address - Zip Code:20646-5975
Practice Address - Country:US
Practice Address - Phone:301-934-4521
Practice Address - Fax:301-934-4523
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-01
Last Update Date:2018-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty