MEDICARE: LINDA GERSON RN-C, PHD

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	1041C0700X	Clinical Social Worker	R035717	MD

General Provider Information

NPI Number	:	1588791164
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LINDA GERSON RN-C, PHD

Provider Business Mailing Address
First Line	:	4801 DORSEY HALL DR STE 200
Second Line	:
City	:	ELLICOTT CITY
State	:	MD
Zip	:	21042-7749
Country	:	US
Telephone Number	:	410-175-1180
Fax Number	:	410-715-1182

Provider Business Practice Location Address
First Line	:	4801 DORSEY HALL DR STE 200
Second Line	:
City	:	ELLICOTT CITY
State	:	MD
Zip	:	21042-7749
Country	:	US
Telephone Number	:	410-175-1180
Fax Number	:	410-715-1182

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

Provider Enumeration Date	:	02/28/2007
Last Update Date	:	07/08/2007

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