Healthcare Provider Details

I. General information

NPI: 1194795021
Provider Name (Legal Business Name): GILDA A. DORSEY CAC-AD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/24/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2117 MARYLAND AVE
BALTIMORE MD
21218-5614
US

IV. Provider business mailing address

2117 MARYLAND AVE
BALTIMORE MD
21218-5614
US

V. Phone/Fax

Practice location:
  • Phone: 410-837-4292
  • Fax: 410-837-0639
Mailing address:
  • Phone: 410-837-4292
  • Fax: 410-837-0639

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberAC0515
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: