MEDICARE: GEOFFREY GATAMBIA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	R203559	MD

General Provider Information

NPI Number	:	1265042865
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GEOFFREY GATAMBIA

Provider Business Mailing Address
First Line	:	394 COLLEGE MANOR CT
Second Line	:
City	:	ARNOLD
State	:	MD
Zip	:	21012-1822
Country	:	US
Telephone Number	:	301-802-8794
Fax Number	:

Provider Business Practice Location Address
First Line	:	394 COLLEGE MANOR CT
Second Line	:
City	:	ARNOLD
State	:	MD
Zip	:	21012-1822
Country	:	US
Telephone Number	:	301-802-8794
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/07/2020
Last Update Date	:	08/07/2020

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Directions to “ GEOFFREY GATAMBIA ” Practice Location

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