Provider Demographics
NPI:1548260797
Name:WARNER, GAIL GRANOF (MD)
Entity type:Individual
Prefix:
First Name:GAIL
Middle Name:GRANOF
Last Name:WARNER
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:GAIL
Other - Middle Name:ANN
Other - Last Name:GRANOF
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:15225 SHADY GROVE RD
Mailing Address - Street 2:#304
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-3254
Mailing Address - Country:US
Mailing Address - Phone:301-840-0660
Mailing Address - Fax:301-330-7583
Practice Address - Street 1:10401 OLD GEORGETOWN RD STE 200
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-1911
Practice Address - Country:US
Practice Address - Phone:240-630-8882
Practice Address - Fax:240-800-4708
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-29
Last Update Date:2025-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0053480208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD51900000Medicaid