Healthcare Provider Details

I. General information

NPI: 1063425478
Provider Name (Legal Business Name): FRANK W. GIBSON, JR. P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2006
Last Update Date: 09/08/2023
Certification Date: 09/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 N POINT BLVD STE 130
BALTIMORE MD
21224-3417
US

IV. Provider business mailing address

201 EASTERN BLVD
BALTIMORE MD
21221-6958
US

V. Phone/Fax

Practice location:
  • Phone: 410-282-7222
  • Fax: 410-288-4009
Mailing address:
  • Phone: 410-282-7222
  • Fax: 410-288-4009

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number01282
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: EARL S OXLEY
Title or Position: MANAGER
Credential:
Phone: 410-391-0047