Active NPI
Gary Victor Emanuel, PHD
- Clinical Psychologist
- Bethesda, MD
National Provider Identifier
1104902022
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 689
- Practice address
- 4933 Auburn Ave
Suite 202
Bethesda, MD 20814 - Phone
- (301) 986-8020
- Fax
- (301) 951-5286
- NPI assigned
- Oct 31, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 689 | MD | Primary |
Addresses
Primary practice location
4933 Auburn Ave
Suite 202
Bethesda, MD 20814
Mailing address
4933 Auburn Ave
Suite 202
Bethesda, MD 20814
Phone (301) 986-8020
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 689 | MD | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1162252800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1281484800000",
"number": "1104902022",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4933 AUBURN AVE",
"address_2": "SUITE 202",
"city": "BETHESDA",
"state": "MD",
"postal_code": "20814",
"telephone_number": "301-986-8020",
"fax_number": "301-951-5286"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4933 AUBURN AVE",
"address_2": "SUITE 202",
"city": "BETHESDA",
"state": "MD",
"postal_code": "20814",
"telephone_number": "301-986-8020",
"fax_number": "301-951-5286"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EMANUEL",
"first_name": "GARY",
"middle_name": "VICTOR",
"name_prefix": "Dr.",
"credential": "PHD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-10-31",
"last_updated": "2010-08-11",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "MD",
"license": "689",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bethesda, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 11, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.