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General NPI Number Information
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NPI Number | 1487657227
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Entity Type | Individual
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Provider Name | GWENNETH O CANCINO M.D.
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Gender | Female
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Dates
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Enumeration Date | 05/24/2005
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Last Update Date | 11/08/2013
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Provider Practice Location Address
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Address Line | 115 W BEL AIR AVENUE
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City | ABERDEEN
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State | MD
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Zip | 21001-3221
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Country | US
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Telephone | 410-272-3377
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Fax | 410-273-1479
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Provider Business Mailing Address
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Address Line | 115 W BEL AIR AVENUE
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City | ABERDEEN
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State | MD
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Zip | 21001-3221
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Country | US
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Telephone | 410-272-1692
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Fax | 410-272-1694
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | D0046268
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License Number State | MD
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