Provider Demographics
NPI:1568863843
Name:GENTILE, MICAH (PA-C)
Entity type:Individual
Prefix:
First Name:MICAH
Middle Name:
Last Name:GENTILE
Suffix:
Gender:
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7700 ARLINGTON BLVD STE 5101
Mailing Address - Street 2:
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22042-5101
Mailing Address - Country:US
Mailing Address - Phone:301-295-4600
Mailing Address - Fax:
Practice Address - Street 1:4650 TAYLOR RD
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20889-5101
Practice Address - Country:US
Practice Address - Phone:301-319-2853
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-05
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60527256363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant