Provider Demographics
NPI:1053433367
Name:PERVALL, GINA CHERI (MD)
Entity type:Individual
Prefix:
First Name:GINA
Middle Name:CHERI
Last Name:PERVALL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2903 SAINT REGIS WAY
Mailing Address - Street 2:
Mailing Address - City:MITCHELLVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20721-2595
Mailing Address - Country:US
Mailing Address - Phone:301-390-8799
Mailing Address - Fax:301-218-2445
Practice Address - Street 1:616 H ST NW
Practice Address - Street 2:LOWER LEVEL
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20001-5800
Practice Address - Country:US
Practice Address - Phone:202-636-7153
Practice Address - Fax:202-636-7180
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2010-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC20302207R00000X
MDD48015207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDD48015OtherLICENSE
DC20302OtherLICENSE