Healthcare Provider Details

I. General information

NPI: 1114165354
Provider Name (Legal Business Name): GADSON, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2009
Last Update Date: 01/26/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7525 GREENWAY CENTER DR
GREENBELT MD
20770-3509
US

IV. Provider business mailing address

7525 GREENWAY CENTER DR
GREENBELT MD
20770-3509
US

V. Phone/Fax

Practice location:
  • Phone: 301-441-7856
  • Fax: 301-441-4655
Mailing address:
  • Phone: 301-441-7856
  • Fax: 301-441-4655

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License NumberD4118
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License NumberD4118
License Number StateMD

VIII. Authorized Official

Name: MRS. BERNADETTE DENISE HARRELSON
Title or Position: PROJECT MANAGER
Credential: HEALTH ADMINISTRATOR
Phone: 301-641-7856