Provider Demographics
NPI:1447487897
Name:GILMORE, BRENT ALAN (MD)
Entity type:Individual
Prefix:DR
First Name:BRENT
Middle Name:ALAN
Last Name:GILMORE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1124 WALKER RD
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:VA
Mailing Address - Zip Code:22066-1818
Mailing Address - Country:US
Mailing Address - Phone:202-841-6406
Mailing Address - Fax:
Practice Address - Street 1:3800 RESERVOIR RD NW, CCC BUILDING, LOWER LEVEL RM CL60
Practice Address - Street 2:GEORGETOWN UNIVERSITY MEDICAL CENTER
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20007
Practice Address - Country:US
Practice Address - Phone:202-444-8640
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-12
Last Update Date:2019-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD043308207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology