Healthcare Provider Details

I. General information

NPI: 1659307049
Provider Name (Legal Business Name): GLORIA J. FORGASH C.N.M.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5450 KNOLL NORTH DR SUITE 320
COLUMBIA MD
21045-2300
US

IV. Provider business mailing address

5450 KNOLL NORTH DR SUITE 320
COLUMBIA MD
21045-2300
US

V. Phone/Fax

Practice location:
  • Phone: 410-964-4600
  • Fax: 410-740-8654
Mailing address:
  • Phone: 410-964-4600
  • Fax: 410-740-8654

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberR047883
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: