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General NPI Number Information
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NPI Number | 1538437223
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Entity Type | Individual
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Provider Name | CHRISTINE T GARDELLA PA-C
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Gender | Female
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Dates
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Enumeration Date | 12/08/2011
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Last Update Date | 08/18/2015
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Provider Practice Location Address
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Address Line | 12070 OLD LINE CTR SUITE 302
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City | WALDORF
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State | MD
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Zip | 20602-2513
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Country | US
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Telephone | 301-645-6667
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Fax | 301-870-9722
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Provider Business Mailing Address
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Address Line | 115 ROESLER RD
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City | GLEN BURNIE
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State | MD
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Zip | 21060-6519
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Country | US
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Telephone | 410-766-8009
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Fax | 410-766-8022
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | C0004642
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License Number State | MD
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