Healthcare Provider Details

I. General information

NPI: 1386717148
Provider Name (Legal Business Name): ELLA MAE GAYOSO-ADAM M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2006
Last Update Date: 01/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7556 TEAGUE RD SUITE 430
HANOVER MD
21076-1213
US

IV. Provider business mailing address

301 HOSPITAL DR
GLEN BURNIE MD
21061-5803
US

V. Phone/Fax

Practice location:
  • Phone: 410-553-8260
  • Fax: 410-553-8261
Mailing address:
  • Phone: 410-787-4594
  • Fax: 410-787-4846

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberD0053717
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberMD21610
License Number StateDC
# 3
Primary TaxonomyY
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License NumberD0053717
License Number StateMD
# 4
Primary TaxonomyN
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License NumberMD21610
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: