1720165574 NPI number — MR. LARRY ANTHONY GAMBLE L.C.S.W.-C.

Table of content: MR. LARRY ANTHONY GAMBLE L.C.S.W.-C. (NPI 1720165574)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720165574 NPI number — MR. LARRY ANTHONY GAMBLE L.C.S.W.-C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GAMBLE
Provider First Name:
LARRY
Provider Middle Name:
ANTHONY
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
L.C.S.W.-C.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1720165574
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14127 YORKSHIRE WOODS DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SILVER SPRING
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20906-2872
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
240-777-1444
Provider Business Mailing Address Fax Number:
240-777-3381

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
751 TWINBROOK PKWY STE 2
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROCKVILLE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20851-1499
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
240-281-4513
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  09477 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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