Basic Information
| Provider Information | |||||||||
| NPI: | 1326046327 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DIX | ||||||||
| FirstName: | GARY | ||||||||
| MiddleName: | ALFRED | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 1000 BESTGATE RD STE 400 | ||||||||
| Address2: | |||||||||
| City: | ANNAPOLIS | ||||||||
| State: | MD | ||||||||
| PostalCode: | 214013371 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4102662720 | ||||||||
| FaxNumber: | 4102240209 | ||||||||
| Practice Location | |||||||||
| Address1: | 1000 BESTGATE RD STE 400 | ||||||||
| Address2: | |||||||||
| City: | ANNAPOLIS | ||||||||
| State: | MD | ||||||||
| PostalCode: | 214013371 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4102662720 | ||||||||
| FaxNumber: | 4102240209 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/13/2005 | ||||||||
| LastUpdateDate: | 11/21/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207T00000X | D0055232 | MD | Y | Allopathic & Osteopathic Physicians | Neurological Surgery |
ID Information
| ID | Type | State | Issuer | Description | 60967804 | 01 | BCBS | OTHER | 60967806 | 01 | BCBS | OTHER | W8490003 | 01 | DC | BCBS | OTHER | 3641780 | 01 | AETNA HMO | OTHER | 60967807 | 01 | MD | BCBS | OTHER | 60967808 | 01 | MD | BCBS | OTHER | 804001000 | 01 | AMERIGROUP | OTHER | 394843 | 01 | MAMSI | OTHER | 487760200 | 01 | FEDERAL WORKMANS COMP | OTHER | D3800003 | 01 | DC | BCBS | OTHER | 7580269 | 01 | AETNA | OTHER | 60967803 | 01 | BCBS | OTHER | 804001000 | 05 | MD | MEDICAID | J4570005 | 01 | DC | BCBS | OTHER |