Healthcare Provider Details

I. General information

NPI: 1306705355
Provider Name (Legal Business Name): MRS. GABRIELLE WACHTER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/16/2026
Last Update Date: 01/16/2026
Certification Date: 01/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6615 TUSCARORA DR
FREDERICK MD
21702-2811
US

IV. Provider business mailing address

6615 TUSCARORA DR
FREDERICK MD
21702-2811
US

V. Phone/Fax

Practice location:
  • Phone: 240-626-4040
  • Fax:
Mailing address:
  • Phone: 240-626-4040
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number7166-88
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateMD
# 3
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number3573-16
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: