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General NPI Number Information
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NPI Number | 1578567939
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Entity Type | Individual
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Provider Name | MICHAEL C GAUDIOSE MD
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Gender | Male
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Dates
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Enumeration Date | 06/13/2005
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 11110 MEDICAL CAMPUS RD STE 200
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City | HAGERSTOWN
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State | MD
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Zip | 21742-6797
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Country | US
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Telephone | 301-714-4400
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Fax | 301-714-4424
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Provider Business Mailing Address
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Address Line | 22 ST PAUL DR STE 200
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City | CHAMBERSBURG
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State | PA
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Zip | 17201-1036
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Country | US
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Telephone | 717-709-7922
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Fax | 717-263-2055
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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 | MD023572E
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License Number State | PA
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