Healthcare Provider Details

I. General information

NPI: 1598884207
Provider Name (Legal Business Name): TANGELA M GAINES PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2007
Last Update Date: 12/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 MEDICAL PARKWAY ACUTE CARE PAVILION
ANNAPOLIS MD
21401-3280
US

IV. Provider business mailing address

PO BOX 12622
BELFAST ME
04915-4017
US

V. Phone/Fax

Practice location:
  • Phone: 443-481-6482
  • Fax: 443-481-6515
Mailing address:
  • Phone: 443-481-6569
  • Fax: 443-481-6515

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberC03729
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: