Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207VG0400X | Gynecologist | D0053717 | MD |
N | 207VG0400X | Gynecologist | MD21610 | DC |
Y | 207VX0000X | Obstetrician | D0053717 | MD |
N | 207VX0000X | Obstetrician | MD21610 | DC |
NPI | 1386717148 |
---|---|
Provider Name | Dr. Ella Mae Gayoso-Adam |
First Address | Glen Burnie, MD 21061-5803 |
Second Address | Hanover, MD 21076-1213 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/11/2006 |
Last Update Date | 13/01/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
409092600 | (05) | MD |
G85581 | (02) | MD |