Healthcare Provider Details

I. General information

NPI: 1508643529
Provider Name (Legal Business Name): MRS. GINA R JAMES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/12/2023
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16821 SWANSON RD
UPPER MARLBORO MD
20774-9045
US

IV. Provider business mailing address

16821 SWANSON RD
UPPER MARLBORO MD
20774-9045
US

V. Phone/Fax

Practice location:
  • Phone: 301-537-8633
  • Fax:
Mailing address:
  • Phone: 301-537-8633
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberLC18108
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: