Provider Demographics
NPI:1427091412
Name:GUY W. GARGOUR, M.D., P.A.
Entity type:Organization
Organization Name:GUY W. GARGOUR, M.D., P.A.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GUY
Authorized Official - Middle Name:W
Authorized Official - Last Name:GARGOUR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-856-2323
Mailing Address - Street 1:10401 HOSPITAL DRIVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:CLINTON
Mailing Address - State:MD
Mailing Address - Zip Code:20735-3150
Mailing Address - Country:US
Mailing Address - Phone:301-856-2323
Mailing Address - Fax:301-856-5619
Practice Address - Street 1:10401 HOSPITAL DRIVE
Practice Address - Street 2:SUITE 101
Practice Address - City:CLINTON
Practice Address - State:MD
Practice Address - Zip Code:20735-3150
Practice Address - Country:US
Practice Address - Phone:301-856-2323
Practice Address - Fax:301-856-5619
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-14
Last Update Date:2007-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
G00347Medicare ID - Type Unspecified