Healthcare Provider Details

I. General information

NPI: 1124487111
Provider Name (Legal Business Name): GLADSTONE PSYCHIATRY AND WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/18/2016
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9841 BROKEN LAND PKWY STE 211
COLUMBIA MD
21046-3068
US

IV. Provider business mailing address

9841 BROKEN LAND PKWY STE 211
COLUMBIA MD
21046-3068
US

V. Phone/Fax

Practice location:
  • Phone: 443-708-5856
  • Fax: 667-212-5095
Mailing address:
  • Phone: 443-708-5856
  • Fax: 667-212-5095

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberD0045477
License Number StateMD

VIII. Authorized Official

Name: ANTHONY G. MASSEY
Title or Position: CEO
Credential: MD
Phone: 443-708-5856